Provider Demographics
NPI:1639221385
Name:MORRIS, JUDY K (LNM)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5038
Mailing Address - Country:US
Mailing Address - Phone:860-583-1800
Mailing Address - Fax:860-584-4256
Practice Address - Street 1:122 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5038
Practice Address - Country:US
Practice Address - Phone:860-583-1800
Practice Address - Fax:860-584-4256
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000057367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000057OtherNURSE MIDWIFE - LICENSED