Provider Demographics
NPI:1629142484
Name:MORROW, PAULINE DOUGLAS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:DOUGLAS
Last Name:MORROW
Suffix:
Gender:F
Credentials:PA-C
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 17651
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-0651
Mailing Address - Country:US
Mailing Address - Phone:303-652-9222
Mailing Address - Fax:303-652-9333
Practice Address - Street 1:6800 N 79TH ST
Practice Address - Street 2:STE. 202
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7042
Practice Address - Country:US
Practice Address - Phone:303-652-9222
Practice Address - Fax:303-652-9333
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS79998Medicare UPIN