Provider Demographics
NPI:1295223782
Name:MORRIS, HEATHER LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:MORRIS
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 1:15268 S DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5040
Mailing Address - Country:US
Mailing Address - Phone:734-240-0520
Mailing Address - Fax:734-240-0512
Practice Address - Street 1:15268 S DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5040
Practice Address - Country:US
Practice Address - Phone:734-240-0520
Practice Address - Fax:734-240-0512
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703117035164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse