MEDICARE: CHARLOTTE ELIZABETH MORRIS CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	MW-008155-L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	597586	OTHER	PA	MEDICARE GROUP

General Provider Information

NPI Number	:	1184953697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE ELIZABETH MORRIS CNM

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-9010
Fax Number	:	215-226-8285

Provider Business Practice Location Address
First Line	:	2301 E ALLEGHENY AVE
Second Line	:	4TH FL HELENE FULD BUILDING
City	:	PHILA
State	:	PA
Zip	:	19134-4427
Country	:	US
Telephone Number	:	215-926-3700
Fax Number	:	215-926-3703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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