Provider Demographics
NPI:1083262174
Name:MORGAN, JALESISA CHENELL
Entity Type:Individual
Prefix:
First Name:JALESISA
Middle Name:CHENELL
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8781 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4705
Mailing Address - Country:US
Mailing Address - Phone:513-602-0479
Mailing Address - Fax:
Practice Address - Street 1:8781 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4705
Practice Address - Country:US
Practice Address - Phone:513-602-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165679.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse