Provider Demographics
NPI:1750450862
Name:MORRISON, MONICA LENORA (PAC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LENORA
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 14TH AVE W APT 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1341
Mailing Address - Country:US
Mailing Address - Phone:206-301-9096
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003628363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2637MOOtherBLUE SHIELD #
WA0039581OtherLABOR AND INDUSTRIES #
WA8414443Medicaid
WAUS7978602OtherAETNA SPECIALIST PIN
WA8414443Medicaid
8850249Medicare ID - Type Unspecified