Provider Demographics
NPI:1649637869
Name:MORSE, JENNIFER (RN, BSN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MORSE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 CONE FLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8576
Mailing Address - Country:US
Mailing Address - Phone:217-741-3816
Mailing Address - Fax:
Practice Address - Street 1:1640 CONE FLOWER WAY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8576
Practice Address - Country:US
Practice Address - Phone:217-741-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250166163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic