Provider Demographics
NPI:1366606618
Name:MERTINS, CAROL ANN (APRN, BC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:MERTINS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-4730
Mailing Address - Country:US
Mailing Address - Phone:920-206-7797
Mailing Address - Fax:920-206-0870
Practice Address - Street 1:415 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4730
Practice Address - Country:US
Practice Address - Phone:920-206-7797
Practice Address - Fax:920-206-0870
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3055-33364SA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health