Provider Demographics
NPI:1679806616
Name:MERRIOTT, LAURA JANE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JANE
Last Name:MERRIOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DWORACZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4402 PEACH ST.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:814-866-2010
Mailing Address - Fax:
Practice Address - Street 1:4402 PEACH ST.
Practice Address - Street 2:SUITE 302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-866-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN334080L363L00000X
PASP002262G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner