Provider Demographics
NPI:1407842867
Name:MORSE, ELLEN PATRICIA (CFNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:PATRICIA
Last Name:MORSE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0579
Mailing Address - Country:US
Mailing Address - Phone:928-337-4301
Mailing Address - Fax:928-337-2269
Practice Address - Street 1:470 W CLEVELAND
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:918-333-2683
Practice Address - Fax:928-333-5595
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN069943363LF0000X
CORN000000115893363LF0000X
NY335358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0609250OtherBLUECROSS BLUESHIELD PROVIDER
AZZ78372OtherMEDICARE LEGACY
AZZ78376Medicare PIN