Healthcare Provider Details

I. General information

NPI: 1275844623
Provider Name (Legal Business Name): JACQUES JOSEPH MORIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

(4) DRAHTHAMMER, STR.
ANBERG BAVARIA
92224
DE

IV. Provider business mailing address

CMR 411 P.O. BOX 964 JACQUES MORIN
APO AE
09112-0964
US

V. Phone/Fax

Practice location:
  • Phone: 499662834020
  • Fax:
Mailing address:
  • Phone: 499662834020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR034594
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: