Provider Demographics
NPI:1447340971
Name:MORRISSETTE, JANICE S (RN)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:S
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3713
Mailing Address - Country:US
Mailing Address - Phone:251-343-4979
Mailing Address - Fax:251-343-6013
Practice Address - Street 1:7000 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3713
Practice Address - Country:US
Practice Address - Phone:251-343-4979
Practice Address - Fax:251-343-6013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631008104 TRICAREOtherDME PROIDER
AL009964120Medicaid
AL631008104 ACMOtherDME SUPPLIER
MS0440974 MEDICAIDOtherDME PROVIDER
AL510-56006 BCBSOtherDME PROVIDER
AL0367490001Medicare NSC