Healthcare Provider Details

I. General information

NPI: 1376320457
Provider Name (Legal Business Name): SHARA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 BROADWAY
MERRILLVILLE IN
46410-2636
US

IV. Provider business mailing address

5701 BROADWAY
MERRILLVILLE IN
46410-2636
US

V. Phone/Fax

Practice location:
  • Phone: 888-565-2412
  • Fax:
Mailing address:
  • Phone: 888-565-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberX5N7B8C3
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: