Provider Demographics
NPI:1669747481
Name:MORRIS, JACQUELIN ANDREA (AS)
Entity type:Individual
Prefix:MRS
First Name:JACQUELIN
Middle Name:ANDREA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NARO LN
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2716
Mailing Address - Country:US
Mailing Address - Phone:631-544-0643
Mailing Address - Fax:
Practice Address - Street 1:7 NARO LN
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-2716
Practice Address - Country:US
Practice Address - Phone:631-544-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654314-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse