Healthcare Provider Details

I. General information

NPI: 1659338101
Provider Name (Legal Business Name): MAUREEN ELIZABETH MORRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S MAIN ST
WEST HARTFORD CT
06110-1646
US

IV. Provider business mailing address

445 S MAIN ST
WEST HARTFORD CT
06110-1646
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-7111
  • Fax: 860-561-7272
Mailing address:
  • Phone: 860-696-2200
  • Fax: 860-561-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001258
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001258
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: