Healthcare Provider Details

I. General information

NPI: 1508535469
Provider Name (Legal Business Name): GWENDOLYN L MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8713 BEVERLY BOULEVARD
WEST HOLLYWOOD CA
90048
US

IV. Provider business mailing address

9227 RESEDA BLVD
NORTHRIDGE CA
91324-3137
US

V. Phone/Fax

Practice location:
  • Phone: 202-487-5039
  • Fax:
Mailing address:
  • Phone: 202-487-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number832910
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014528
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1156326
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1156326
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: