Provider Demographics
NPI:1912387838
Name:MORRISON-NOZIK, JACQUELINE (DPM)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MORRISON-NOZIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GOLDFARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2126B N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1532
Mailing Address - Country:US
Mailing Address - Phone:864-231-6395
Mailing Address - Fax:864-231-6520
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-3037
Practice Address - Fax:440-960-4624
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC670213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty