Basic Information
| Provider Information | |||||||||
| NPI: | 1396922548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERKLING | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 104 | ||||||||
| Address2: | |||||||||
| City: | TOQUEVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035872142 | ||||||||
| FaxNumber: | 3037953568 | ||||||||
| Practice Location | |||||||||
| Address1: | 7720 S BROADWAY STE 440 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037950890 | ||||||||
| FaxNumber: | 3037953568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SW0102X | 81875 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 81875 | 01 | CO | STATE LICENSE | OTHER | 11864576-4405 | 01 | UT | UTAH APRN | OTHER |