Provider Demographics
NPI:1922406982
Name:MERCADO, MICAELA G (RN)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:G
Last Name:MERCADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 HUMBOLDT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9203
Mailing Address - Country:US
Mailing Address - Phone:916-482-4856
Mailing Address - Fax:
Practice Address - Street 1:1469 HUMBOLDT RD STE 200
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9203
Practice Address - Country:US
Practice Address - Phone:916-482-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814583163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory