Provider Demographics
NPI:1043599004
Name:MORRISON, MARVIN JOSEPH (APRN)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:JOSEPH
Last Name:MORRISON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CENTER STREET
Mailing Address - Street 2:P. O. BOX 930
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:305 CENTER STREET
Practice Address - Street 2:
Practice Address - City:EAST CARBON
Practice Address - State:UT
Practice Address - Zip Code:84520-0930
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:435-888-2270
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT338876-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner