Provider Demographics
NPI:1205613460
Name:MORRIS, ANGEL ANTOINETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANTOINETTE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:ANGEL
Other - Middle Name:ANTOINETTE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANGEL MORRIS
Mailing Address - Street 1:16989 CORAL GABLES ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4764
Mailing Address - Country:US
Mailing Address - Phone:313-318-0823
Mailing Address - Fax:
Practice Address - Street 1:28050 SOUTHFIELD RD STE 250
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2835
Practice Address - Country:US
Practice Address - Phone:313-318-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704336303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse