MEDICARE: MRS. JESSICA MICHELLE MORRIS CNM

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	367A00000X	Advanced Practice Midwife	209011458	IL

General Provider Information

NPI Number	:	1285053876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MICHELLE MORRIS CNM

Provider Business Mailing Address
First Line	:	2112 25TH AVE
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5317
Country	:	US
Telephone Number	:	309-794-7088
Fax Number	:	309-558-2815

Provider Business Practice Location Address
First Line	:	2112 25TH AVE
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5317
Country	:	US
Telephone Number	:	309-794-7088
Fax Number	:	309-558-2815

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/10/2014

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