Provider Demographics
NPI:1619300167
Name:MORRIS, MIRANDA RHYNE
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:RHYNE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 SALEM DR APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1464
Mailing Address - Country:US
Mailing Address - Phone:843-450-6746
Mailing Address - Fax:
Practice Address - Street 1:1137 SALEM DR APT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1464
Practice Address - Country:US
Practice Address - Phone:843-450-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program