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NPI Code Detail

MEDICARE: SUSANA NICOLE MORPHIS RD

MEDICARE: SUSANA NICOLE MORPHIS RD
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
1133V00000XRegistered Dietitian
2133V00000XRegistered Dietitian86081374WI

General Provider Information

NPI Number : 1770190498
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA NICOLE MORPHIS RD
Provider Business Mailing Address
First Line : 324 S 2ND ST APT 412
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-1617
Country : US
Telephone Number : 404-803-7447
Fax Number :
Provider Business Practice Location Address
First Line : 3365 S 103RD ST STE 100
Second Line :
City : MILWAUKEE
State : WI
Zip : 53227-4162
Country : US
Telephone Number : 404-803-7447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2020
Last Update Date : 06/26/2025

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Directions to “ SUSANA NICOLE MORPHIS RD” Practice Location

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