Provider Demographics
NPI:1952296931
Name:MERILICE, MIREILLE (RN)
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:MERILICE
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 1:1249 BROOKLYN AVE APT NO2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5517
Mailing Address - Country:US
Mailing Address - Phone:718-462-4250
Mailing Address - Fax:
Practice Address - Street 1:1700 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2627
Practice Address - Country:US
Practice Address - Phone:212-289-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510972-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse