Provider Demographics
NPI:1619127081
Name:MORSE, ANNOLYN MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNOLYN
Middle Name:MARIE
Last Name:MORSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ANNOLYN
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:360 CLINTON AVE
Mailing Address - Street 2:APT. 4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1174
Mailing Address - Country:US
Mailing Address - Phone:718-399-9714
Mailing Address - Fax:718-399-9714
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:SUIT 1A
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2519
Practice Address - Country:US
Practice Address - Phone:877-608-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225660-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse