Provider Demographics
NPI:1750168837
Name:FLEETWOOD-MERRITT, ALICE MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MICHELLE
Last Name:FLEETWOOD-MERRITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 BERTHA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1957
Mailing Address - Country:US
Mailing Address - Phone:330-937-3584
Mailing Address - Fax:
Practice Address - Street 1:768 BERTHA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1957
Practice Address - Country:US
Practice Address - Phone:330-937-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134687164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse