Provider Demographics
NPI:1639152242
Name:MORRISON, MARY (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 DONNER PASS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4851
Mailing Address - Country:US
Mailing Address - Phone:530-582-8535
Mailing Address - Fax:530-582-8841
Practice Address - Street 1:10833 DONNER PASS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4851
Practice Address - Country:US
Practice Address - Phone:530-582-8535
Practice Address - Fax:530-582-8841
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAK222165164W00000X
CA4436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22573Medicare UPIN