Healthcare Provider Details

I. General information

NPI: 1912387838
Provider Name (Legal Business Name): JACQUELINE MORRISON-NOZIK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE GOLDFARB

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOLBE RD
LORAIN OH
44053-1611
US

IV. Provider business mailing address

2126B N HIGHWAY 81
ANDERSON SC
29621-1532
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-3037
  • Fax: 440-960-4624
Mailing address:
  • Phone: 864-231-6395
  • Fax: 864-231-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number670
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: