MR. GARY JOHN CLINTON MERSEREAU SR. (NPI# 1114542065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114542065 |
| Entity Type | Individual |
| Full Name | MR. GARY JOHN CLINTON MERSEREAU SR. |
| Credential | BSN, RN |
| Practice Address |
914 S Scheuber Rd Centralia WA 98531-9027 |
| Mailing Address |
815 Wayne Dr Centralia WA 98531-9024 |
| Practice Telephone | 3603308785 |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WE0003X |
Registered Nurse Specialization: Emergency |
RN60383846 | WA | Nursing Service Providers |
| Street Address |
914 S SCHEUBER RD |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531-9027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982600805 | Leena Carriere | Anesthesiology | 914 S Scheuber Rd, Pmg Sw Wa Centralia Anesthesiology, Centralia, WA 98531-9027 | 2005-06-24 |
| 1366077745 | Andrew J Maasdam | Nurse Anesthetist, Certified Registered | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-03-06 |
| 1447884374 | Michelle Stover | Registered Nurse | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-02-29 |
| 1932748993 | Erika Anne Laurentz | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-12-22 |
| 1952942567 | Ashley Marie Wheeler | Emergency Medicine | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-10-04 |
| 1619537057 | Rebecca Kathryn Mcneil | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-06-18 |
| 1982269395 | Jennifer Green | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-05-01 |
| 1033698519 | Jennifer Ann Reuter | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531 | 2018-08-07 |
| 1629554274 | Rachelle Marie Peterson | Occupational Therapist | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2018-07-17 |
| 1245716901 | Ryan Marin | Physical Therapist | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2018-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 163WE0003X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Emergency |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740810381 | Leah Menucha Millman | Registered Nurse | 1515 Nw 52nd St Apt 304, Seattle, WA 98107-3840 | 2020-01-23 |
| 1790287811 | Andrew Erick Isaacson | Registered Nurse | 1314 Kimball Ave, Richland, WA 99354-3206 | 2018-03-05 |
| 1205349602 | Melissa Lee | Registered Nurse | 5512 Ne 229th Ct, Vancouver, WA 98682-9633 | 2017-11-08 |
| 1801279245 | Amanda Fox | Registered Nurse | Madiagan Army Medical Ctr, 9040 Reid Street, Attn: Mchj-clq-c, Tacoma, WA 98431-0001 | 2015-07-02 |
| 1548676851 | David Albershardt | Registered Nurse | 5409 Ne 349th Ave, Camas, WA 98607-9685 | 2014-07-08 |
| 1639444961 | Tina Morrison | Registered Nurse | 3224 S Saltese Lake Rd, Greenacres, WA 99016-6012 | 2012-03-20 |
| 1578860821 | Paula Georgette Newman-skomski | Registered Nurse | 6512 57th Dr Ne, Marysville, WA 98270-6130 | 2011-02-23 |
| 1033411830 | Tanya Marie Mason | Registered Nurse | 39 Shortcut Rd, Inchelium, WA 99138 | 2010-11-30 |
| 1396983433 | Kit Wilson | Registered Nurse | 3000 Ne 4th St, Renton Technical College, Renton, WA 98056-4195 | 2009-01-28 |
| 1861667305 | Mary L Flick | Registered Nurse | 242 Monroe St, Port Townsend, WA 98368-5709 | 2008-04-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.