Healthcare Provider Details

I. General information

NPI: 1053390575
Provider Name (Legal Business Name): JUDITH L MORRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CANDACE ST
PROVIDENCE RI
02908-3747
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0550
  • Fax: 404-444-0425
Mailing address:
  • Phone: 401-444-0400
  • Fax: 401-444-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN14259
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: