Basic Information
| Provider Information | |||||||||
| NPI: | 1710597224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERSHON | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5640 STATE ROUTE 325 | ||||||||
| Address2: | |||||||||
| City: | PATRIOT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456589282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407940563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 272 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456019031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407797500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | LE00033290 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00033290 | 01 | OH | OHIO BOARD OF NURSING | OTHER | 381235 | 01 | OH | OHIO BOARD OF NURSING - RN | OTHER |