Healthcare Provider Details

I. General information

NPI: 1306464193
Provider Name (Legal Business Name): CYNTHIA DIANE MORRELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LEVESQUE DR STE 9
ELIOT ME
03903-2073
US

IV. Provider business mailing address

15 ALDER LN
BERWICK ME
03901-2568
US

V. Phone/Fax

Practice location:
  • Phone: 978-857-7286
  • Fax:
Mailing address:
  • Phone: 978-857-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN152323
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberMT6247
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN73183
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: