Provider Demographics
NPI:1477515914
Name:MORRIS, JENNIFER JUNA KAY (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JUNA KAY
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:PO BOX 276
Mailing Address - Street 2:107 SCHOOL STREET
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-0276
Mailing Address - Country:US
Mailing Address - Phone:608-523-4365
Mailing Address - Fax:
Practice Address - Street 1:107 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-9784
Practice Address - Country:US
Practice Address - Phone:608-523-4365
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39960700Medicaid