Healthcare Provider Details

I. General information

NPI: 1356792410
Provider Name (Legal Business Name): MELISSA MORRISON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E OSBORN RD
PHOENIX AZ
85016-7236
US

IV. Provider business mailing address

73 W WILSHIRE DR
PHOENIX AZ
85003-1024
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-3388
  • Fax:
Mailing address:
  • Phone: 602-516-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTAP8772
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: