Provider Demographics
NPI:1073025813
Name:MORRIS, MARTEZ RHANDELL (LPN)
Entity Type:Individual
Prefix:MR
First Name:MARTEZ
Middle Name:RHANDELL
Last Name:MORRIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SEVENHILLS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2701
Mailing Address - Country:US
Mailing Address - Phone:513-850-6136
Mailing Address - Fax:
Practice Address - Street 1:1845 SEVENHILLS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2701
Practice Address - Country:US
Practice Address - Phone:513-850-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.154353.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty