Provider Demographics
NPI:1427562347
Name:MORRIS, NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S LYNCHBURG ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1146
Mailing Address - Country:US
Mailing Address - Phone:410-778-2533
Mailing Address - Fax:
Practice Address - Street 1:125 S LYNCHBURG ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1146
Practice Address - Country:US
Practice Address - Phone:410-778-2533
Practice Address - Fax:410-778-6882
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MDR157886163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No174H00000XOther Service ProvidersHealth Educator