Provider Demographics
NPI:1326675364
Name:MORRISON, MICHELE D
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:D
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 1:457 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1111
Mailing Address - Country:US
Mailing Address - Phone:215-600-5395
Mailing Address - Fax:
Practice Address - Street 1:457 E HIGH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1111
Practice Address - Country:US
Practice Address - Phone:215-600-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA43883601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4388601OtherNON-MEDICAL HOME HEALTH CARE
PA837849OtherNON-MEDICAL HOME HEALTH CARE