Healthcare Provider Details

I. General information

NPI: 1477792372
Provider Name (Legal Business Name): MORRIS LEONARD LEWIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 229N
SAINT PAUL MN
55114
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 229N
SAINT PAUL MN
55114-1902
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-3115
  • Fax: 651-645-2752
Mailing address:
  • Phone: 651-645-3115
  • Fax: 651-645-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR133319-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: