Provider Demographics
NPI:1679573265
Name:MORRISON, DENISE L (PA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:L
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 STOLLER RD
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98650-9712
Mailing Address - Country:US
Mailing Address - Phone:509-637-4728
Mailing Address - Fax:509-395-2031
Practice Address - Street 1:212 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-0212
Practice Address - Country:US
Practice Address - Phone:509-493-2133
Practice Address - Fax:509-493-9543
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2643363A00000X
WAPA60157540363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA765113Medicaid
AZ720450Medicaid
AR70806Medicare ID - Type Unspecified
WA503835Medicare Oscar/Certification
AZP62176Medicare UPIN
AZ720450Medicaid