Healthcare Provider Details

I. General information

NPI: 1376619684
Provider Name (Legal Business Name): JODY MORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR #303
NAPERVILLE IL
60563-9789
US

IV. Provider business mailing address

1149 HOBSON MILL DR
NAPERVILLE IL
60540-8132
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-6540
  • Fax:
Mailing address:
  • Phone: 630-305-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-006167
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.231750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: