Provider Demographics
NPI:1417646928
Name:MORRISON, MELVA LAJEAN
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:LAJEAN
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 1:10126 TANGIERS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-7548
Mailing Address - Country:US
Mailing Address - Phone:936-355-7757
Mailing Address - Fax:
Practice Address - Street 1:925 PAYNE AVE SUITE B2
Practice Address - Street 2:PMB 1027
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130
Practice Address - Country:US
Practice Address - Phone:346-277-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor