Healthcare Provider Details

I. General information

NPI: 1598069205
Provider Name (Legal Business Name): JOAN MORRIS APN/CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

349 CAREY CT
BLOOMINGDALE IL
60108-8805
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-6523
  • Fax: 847-696-3394
Mailing address:
  • Phone: 630-745-7687
  • Fax: 847-723-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.181994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: