Provider Demographics
NPI:1023389608
Name:JANICE S. MORRISSETTE
Entity Type:Organization
Organization Name:JANICE S. MORRISSETTE
Other - Org Name:JAN'S BRA SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORRISSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:251-458-7241
Mailing Address - Street 1:953 SUPER ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2929
Mailing Address - Country:US
Mailing Address - Phone:251-458-7241
Mailing Address - Fax:251-457-6089
Practice Address - Street 1:7000 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3713
Practice Address - Country:US
Practice Address - Phone:251-458-7241
Practice Address - Fax:251-457-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL510-56006335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier