Healthcare Provider Details

I. General information

NPI: 1083395958
Provider Name (Legal Business Name): MACKENZIE OLIVIA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

5 BISHOP AVE
SEEKONK MA
02771-2201
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0549
  • Fax:
Mailing address:
  • Phone: 401-365-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23.007622
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100052
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: