Provider Demographics
NPI:1922121359
Name:MORTON-WIMBERLY, MARILYN MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MICHELLE
Last Name:MORTON-WIMBERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14606 LAKESHORE BLVD.
Mailing Address - Street 2:APT. 1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1263
Mailing Address - Country:US
Mailing Address - Phone:216-481-2566
Mailing Address - Fax:216-481-2566
Practice Address - Street 1:14606 LAKESHORE BLVD.
Practice Address - Street 2:APT. 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1263
Practice Address - Country:US
Practice Address - Phone:216-481-2566
Practice Address - Fax:216-481-2566
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-250417163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2243987Medicaid