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General NPI Number Information
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NPI Number | 1770184434
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Entity Type | Individual
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Provider Name | JACOB SOLOMON MORRILL PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 11/07/2020
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Provider Practice Location Address
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Address Line | 2701 W NORFOLK AVE FL 4
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City | NORFOLK
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State | NE
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Zip | 68701-4407
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Country | US
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Telephone | 402-844-8287
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 SW 36TH ST
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City | LINCOLN
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State | NE
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Zip | 68522-9416
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Country | US
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Telephone | 402-360-3446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2531
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License Number State | NE
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