Provider Demographics
NPI:1992834634
Name:MORRIS, PHYLINESE
Entity Type:Individual
Prefix:
First Name:PHYLINESE
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 1:1710 W.144TH STREET
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2305
Mailing Address - Country:US
Mailing Address - Phone:310-327-7828
Mailing Address - Fax:310-327-7828
Practice Address - Street 1:1710 W.144TH STREET
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-2305
Practice Address - Country:US
Practice Address - Phone:310-327-7828
Practice Address - Fax:310-327-7828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse