Provider Demographics
NPI:1003177437
Name:MORRIS, GERTRUDE OPHELIA (RN)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:OPHELIA
Last Name:MORRIS
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 1:2020 E 41ST STREET,
Mailing Address - Street 2:3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-385-1663
Mailing Address - Fax:718-345-3021
Practice Address - Street 1:110 CHESTER STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-385-1663
Practice Address - Fax:718-345-3021
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440746-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102764OtherRN LICENCE 440746-1