Healthcare Provider Details

I. General information

NPI: 1689493165
Provider Name (Legal Business Name): EBONY MORROW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

1265 RAYNOR DR
VIRGINIA BEACH VA
23456-6871
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-4019
  • Fax:
Mailing address:
  • Phone: 757-202-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001264293
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: