Gary John Clinton Mersereau Sr., BSN, RN

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

RN60383846 Issued in WA

Practice address

914 S Scheuber Rd
Centralia, WA 98531-9027

Phone

(360) 330-8785

NPI assigned

Jun 16, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1114542065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 WAYNE DR",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-330-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERSEREAU",
        "first_name": "GARY",
        "middle_name": "JOHN CLINTON",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "BSN, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "WA",
            "license": "RN60383846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dustin Meridith
• Erica Beth Merrill
• Katelynn Merrill, RN
• Lelia Mae Merrill, LMP
• Charlet Mersereau
• Danae Maree Metcalf, CMA
• Brent William Michaud
• Elise Michelle
• Danielle Brooke Middleton, PTA
• Mikhai C. Ta, DDS, PS (Cascade Dental Center)

• Emergency Registered Nurse in Centralia, WA
• Providers in Centralia, WA by specialty
• Emergency Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.