Provider Demographics
NPI:1720263023
Name:MORSE, PATRICIA NELL
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:NELL
Last Name:MORSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:NELL
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDN
Mailing Address - Street 1:500 WASHINGTON BLVD
Mailing Address - Street 2:#402
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4067
Mailing Address - Country:US
Mailing Address - Phone:708-524-1493
Mailing Address - Fax:
Practice Address - Street 1:500 WASHINGTON BLVD
Practice Address - Street 2:#402
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4067
Practice Address - Country:US
Practice Address - Phone:708-524-1493
Practice Address - Fax:708-524-1493
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric