=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518960947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP D MORIN FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40232 JUNCTION DRIVE
-----------------------------------------------------
City | OAKHURST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-658-6400
-----------------------------------------------------
Fax | 559-658-6460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40232 JUNCTION DRIVE
-----------------------------------------------------
City | OAKHURST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-658-6400
-----------------------------------------------------
Fax | 559-658-6460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 269389
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NPF 5388
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R98839
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------