Healthcare Provider Details

I. General information

NPI: 1609942838
Provider Name (Legal Business Name): ELIZABETH MCCLOY MORRIS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12950 HIGHLAND CROSSING DRIVE STE. H
HERNDON VA
20171
US

IV. Provider business mailing address

12950 HIGHLAND CROSSING DRIVE STE. H
HERNDON VA
20171
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-4200
  • Fax: 703-860-1528
Mailing address:
  • Phone: 703-860-4200
  • Fax: 703-860-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001150236
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024164022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: