Provider Demographics
NPI:1073586541
Name:MORRIS, DEWEY R (CRNA)
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9575
Mailing Address - Country:US
Mailing Address - Phone:724-554-4353
Mailing Address - Fax:
Practice Address - Street 1:1023 BALSAM DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-228-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 215310L367500000X
WV050157367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016456810006Medicaid
OH0131333Medicaid
WV0068081000Medicaid
WV0068081000Medicaid
PA0016456810006Medicaid
WVMO6026651Medicare PIN