Provider Demographics
NPI:1508168279
Name:MORILLO, MARISELA (CRNA)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:MORILLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARISELA
Other - Middle Name:
Other - Last Name:PORRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2032 ALTA MEADOWS LN APT 1112
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1161
Mailing Address - Country:US
Mailing Address - Phone:304-887-8326
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-214-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9404490367500000X
WV66793367500000X
PARN785899367500000X
MERNA213042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020292OtherMEDICAID
WV8249881OtherMEDICARE PTAN