Provider Demographics
NPI:1114013638
Name:MORRISON, CONNIE L (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 RYANS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1722
Mailing Address - Country:US
Mailing Address - Phone:507-372-2921
Mailing Address - Fax:507-372-5789
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1722
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-5789
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN46261208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00067836OtherRR MEDICARE
MN347170500Medicaid
IA0719146Medicaid
MN103901OtherUCARE
MN280R3MOOtherBCBS
MN103901OtherUCARE
H91531Medicare UPIN