Provider Demographics
NPI:1770184434
Name:MORRILL, JACOB SOLOMON (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SOLOMON
Last Name:MORRILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-9416
Mailing Address - Country:US
Mailing Address - Phone:402-360-3446
Mailing Address - Fax:
Practice Address - Street 1:2701 W NORFOLK AVE FL 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4407
Practice Address - Country:US
Practice Address - Phone:402-844-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant