Provider Demographics
NPI:1790120871
Name:MORLAN, JACLYN ROSE
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:ROSE
Last Name:MORLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:MORLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:475 PINEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-3917
Mailing Address - Country:US
Mailing Address - Phone:205-616-7381
Mailing Address - Fax:
Practice Address - Street 1:475 PINEVIEW RD
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-3917
Practice Address - Country:US
Practice Address - Phone:205-616-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program