Healthcare Provider Details

I. General information

NPI: 1154616555
Provider Name (Legal Business Name): NICOLE AISHA MORRISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE 300
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

3008 GALLERY PL APARTMENT 32
WALDORF MD
20602-2442
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-7900
  • Fax:
Mailing address:
  • Phone: 301-893-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030756
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: