Provider Demographics
NPI:1447436852
Name:MERSEREAU, MARGARET ROSE (RN CDE)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:MERSEREAU
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 DANA CT
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9335
Mailing Address - Country:US
Mailing Address - Phone:716-601-5891
Mailing Address - Fax:
Practice Address - Street 1:9425 DANA CT
Practice Address - Street 2:
Practice Address - City:CLARENCE CENTER
Practice Address - State:NY
Practice Address - Zip Code:14032-9335
Practice Address - Country:US
Practice Address - Phone:716-601-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309910-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator