Provider Demographics
NPI:1225682503
Name:MORRISON, EBONY QIANA
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:QIANA
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 1:2123 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2202 RIDGE AVENUE
Practice Address - Street 2:2ND FLOOR RM 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121
Practice Address - Country:US
Practice Address - Phone:267-407-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA424236013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant