Provider Demographics
NPI:1639449309
Name:MORTON, W DOUGLAS JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:W
Middle Name:DOUGLAS
Last Name:MORTON
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LEONARD ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1129
Mailing Address - Country:US
Mailing Address - Phone:508-695-5673
Mailing Address - Fax:
Practice Address - Street 1:37 LEONARD ST
Practice Address - Street 2:APT. 2
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1129
Practice Address - Country:US
Practice Address - Phone:508-695-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN59498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse