Provider Demographics
NPI:1871168658
Name:MORRISON, JOHANNAH EILEEN (PA-C)
Entity type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:EILEEN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 MAIN ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7452
Mailing Address - Country:US
Mailing Address - Phone:978-807-3839
Mailing Address - Fax:
Practice Address - Street 1:948 MAIN ST UNIT 303
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7452
Practice Address - Country:US
Practice Address - Phone:978-807-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant