Provider Demographics
NPI:1972091072
Name:MORRIS, WANDA K
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:K
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 1:1430 NE 97TH RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-8464
Mailing Address - Country:US
Mailing Address - Phone:352-603-4551
Mailing Address - Fax:
Practice Address - Street 1:1430 NE 97TH RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8464
Practice Address - Country:US
Practice Address - Phone:352-603-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide