Carrie Sue Mersereau, CNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

024233 Issued in OH

Practice address

5757 Monclova Rd Ste 26
Maumee, OH 43537-1863

Phone

(419) 893-5557

Fax

(419) 893-5199

NPI assigned

Jan 10, 2017

Last updated

Dec 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Carrie Sue Riley Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1164968483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD STE 26",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-893-5557",
            "fax_number": "419-893-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD STE 26",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-893-5557",
            "fax_number": "419-893-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERSEREAU",
        "first_name": "CARRIE",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-10",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "024233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164968483",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164968483",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Carrie.mersereau@curanahealth.com",
            "affiliation": "Y",
            "endpointDescription": "Company E-mail address",
            "affiliationName": "Curana Health of Ohio",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "419-893-5557",
            "address_1": "5757 Monclova Rd Ste 26",
            "city": "Maumee",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435371863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "RILEY",
            "middle_name": "SUE",
            "prefix": "MS.",
            "credential": "APRN-CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Primary Care Nurse Practitioner in Maumee, OH
• Providers in Maumee, OH by specialty
• Primary Care Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.