Provider Demographics
NPI:1952064834
Name:MORRIS, JOLENE
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5303 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:WI
Mailing Address - Zip Code:54111-9308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N5303 CARROLL RD
Practice Address - Street 2:
Practice Address - City:CECIL
Practice Address - State:WI
Practice Address - Zip Code:54111-9308
Practice Address - Country:US
Practice Address - Phone:920-598-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219737163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse