MEDICARE: TERESA LESHAWN MORTON

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1922461292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LESHAWN MORTON

Provider Business Mailing Address
First Line	:	5051 BOA CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-1501
Country	:	US
Telephone Number	:	561-275-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 BOA CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-1501
Country	:	US
Telephone Number	:	561-275-9123
Fax Number	:

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

Provider Enumeration Date	:	04/03/2016
Last Update Date	:	04/03/2016

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