Provider Demographics
NPI:1952328791
Name:MORRISON, COLLEEN CAMERON (PAC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CAMERON
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-3929
Mailing Address - Fax:401-788-3939
Practice Address - Street 1:3050 DURALEIGH RD STE 111
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5451
Practice Address - Country:US
Practice Address - Phone:984-215-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00280363A00000X
NC0010-07451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant