Provider Demographics
NPI:1710967286
Name:MORRISON, NICHOLAS M (R-PAC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:M
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4601
Mailing Address - Country:US
Mailing Address - Phone:614-788-5000
Mailing Address - Fax:614-788-5100
Practice Address - Street 1:303 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4601
Practice Address - Country:US
Practice Address - Phone:614-788-5000
Practice Address - Fax:614-788-5100
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0103691363A00000X, 363AS0400X
OH50.003476RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH145410OtherMCR OPG PTAN
OH0071043Medicaid
NY02618931Medicaid