Basic Information
| Provider Information | |||||||||
| NPI: | 1407087273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCKLE | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DTR, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | CASTROP CENTER | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405664870 | ||||||||
| FaxNumber: | 7405664871 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | CASTROP CENTER | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405664870 | ||||||||
| FaxNumber: | 7405664871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | RN336250 | OH | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator | 136A00000X | 812016 | N | Dietary & Nutritional Service Providers | Dietetic Technician, Registered |
No ID Information.