Healthcare Provider Details

I. General information

NPI: 1770021677
Provider Name (Legal Business Name): ANDREW LEE MORRIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271
US

IV. Provider business mailing address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4511
  • Fax: 360-716-5782
Mailing address:
  • Phone: 360-716-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60897311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: