Provider Demographics
NPI:1043090053
Name:MERRITT, VERONICA (ASMA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:ASMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44010-9784
Mailing Address - Country:US
Mailing Address - Phone:440-221-5371
Mailing Address - Fax:
Practice Address - Street 1:3504 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9784
Practice Address - Country:US
Practice Address - Phone:440-221-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC565742172A00000X
376K00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide