Provider Demographics
NPI:1881604668
Name:MORRELL, HARLEY G (PA-C)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:G
Last Name:MORRELL
Suffix:
Gender:M
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 1:449 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2232
Mailing Address - Country:US
Mailing Address - Phone:307-754-4559
Mailing Address - Fax:307-754-7733
Practice Address - Street 1:2877 OVERLAND AVE STE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7465
Practice Address - Country:US
Practice Address - Phone:406-651-8197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY298363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical