Provider Demographics
NPI:1083764377
Name:MORRISON, ANGELA B
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:MORRISON
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:PO BOX 52900
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2900
Mailing Address - Country:US
Mailing Address - Phone:337-264-0326
Mailing Address - Fax:337-264-0328
Practice Address - Street 1:5935 CAMERON ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5182
Practice Address - Country:US
Practice Address - Phone:337-264-0326
Practice Address - Fax:337-264-0328
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H326DC66Medicare PIN