MEDICARE: MARY K 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	160764	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160764	OTHER	OH	NURSING BOARD

General Provider Information

NPI Number	:	1992202014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K MORRIS LPN

Provider Business Mailing Address
First Line	:	4573 W MITCHELL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1750
Country	:	US
Telephone Number	:	513-787-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	4573 W MITCHELL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1750
Country	:	US
Telephone Number	:	513-787-1620
Fax Number	:

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/08/2018

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