Provider Demographics
NPI:1619215506
Name:MORISHO, AMISI MAGNE (RNP)
Entity Type:Individual
Prefix:
First Name:AMISI
Middle Name:MAGNE
Last Name:MORISHO
Suffix:
Gender:M
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37097 WINGED FOOT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8012
Mailing Address - Country:US
Mailing Address - Phone:909-800-9072
Mailing Address - Fax:
Practice Address - Street 1:37097 WINGED FOOT RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8012
Practice Address - Country:US
Practice Address - Phone:909-800-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582329163WM0705X
CA20745363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care