MEDICARE: MS. ELLEN PATRICIA MORSE CFNP

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	363LF0000X	Family Nurse Practitioner	RN069943	AZ
2	363LF0000X	Family Nurse Practitioner	RN000000115893	CO
3	363LF0000X	Family Nurse Practitioner	335358	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z78372	OTHER	AZ	MEDICARE LEGACY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0609250	OTHER	AZ	BLUECROSS BLUESHIELD PROVIDER

General Provider Information

NPI Number	:	1407842867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN PATRICIA MORSE CFNP

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-0579
Country	:	US
Telephone Number	:	928-337-4301
Fax Number	:	928-337-2269

Provider Business Practice Location Address
First Line	:	470 W CLEVELAND
Second Line	:
City	:	ST. JOHNS
State	:	AZ
Zip	:	85936
Country	:	US
Telephone Number	:	918-333-2683
Fax Number	:	928-333-5595

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/07/2008

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