Healthcare Provider Details

I. General information

NPI: 1003353673
Provider Name (Legal Business Name): MR. JACOB ANDREW MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E CHOCOLATE AVE
HERSHEY PA
17033-1324
US

IV. Provider business mailing address

441 E CHOCOLATE AVE
HERSHEY PA
17033-1324
US

V. Phone/Fax

Practice location:
  • Phone: 717-533-7850
  • Fax: 717-533-8294
Mailing address:
  • Phone: 717-533-7850
  • Fax: 717-533-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP017133
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: