Provider Demographics
NPI:1366136152
Name:MECIMORE, EMILY LYNNE (RN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNNE
Last Name:MECIMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LYNNE
Other - Last Name:WARDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2031 WOODVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9282
Mailing Address - Country:US
Mailing Address - Phone:276-224-9714
Mailing Address - Fax:
Practice Address - Street 1:2031 WOODVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9282
Practice Address - Country:US
Practice Address - Phone:276-224-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.507682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse