MEDICARE: MR. MARTEZ RHANDELL MORRIS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.154353.MEDS-IV	OH

General Provider Information

NPI Number	:	1073025813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTEZ RHANDELL MORRIS LPN

Provider Business Mailing Address
First Line	:	1845 SEVENHILLS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2701
Country	:	US
Telephone Number	:	513-850-6136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 SEVENHILLS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2701
Country	:	US
Telephone Number	:	513-850-6136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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