Provider Demographics
NPI:1346793072
Name:MORRIS, TINA ROCHELLE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ROCHELLE
Last Name:MORRIS
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 1:2770 CARPENTER RD
Mailing Address - Street 2:220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-4104
Mailing Address - Country:US
Mailing Address - Phone:734-971-6300
Mailing Address - Fax:
Practice Address - Street 1:2770 CARPENTER RD
Practice Address - Street 2:220
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-4104
Practice Address - Country:US
Practice Address - Phone:734-971-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284066163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114014529Medicare Oscar/Certification