Provider Demographics
NPI:1114293073
Name:MORRISON, JACKALYN CAROL (LPN)
Entity Type:Individual
Prefix:MS
First Name:JACKALYN
Middle Name:CAROL
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-3157
Mailing Address - Country:US
Mailing Address - Phone:607-639-2488
Mailing Address - Fax:
Practice Address - Street 1:38 SPRING ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-3157
Practice Address - Country:US
Practice Address - Phone:607-639-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10270246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse