Individual provider Active NPI

Patricia Ann Mervine, RN

  • Pediatric Registered Nurse
  • Tonawanda, NY
National Provider Identifier
1245439710
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Registered NurseTaxonomy code 163WP0200X
License
315007 Issued in NY
Practice address
293 Desmond Dr
Tonawanda, NY 14150-7836
Phone
(716) 308-7778
NPI assigned
Jul 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X 315007 NY Primary

Addresses

Primary practice location

293 Desmond Dr
Tonawanda, NY 14150-7836

Mailing address

293 Desmond Dr
Tonawanda, NY 14150-7836
Phone (716) 308-7778

Other identifiers 1

IdentifierTypeStateIssuer
02592607MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1245439710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 DESMOND DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141507836",
            "telephone_number": "716-308-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 DESMOND DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141507836",
            "telephone_number": "716-308-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERVINE",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "NY",
            "license": "315007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02592607",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tonawanda, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.