Provider Demographics
NPI:1548718596
Name:MORRIS, JEAN ANTOINETTE (LPN)
Entity type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:ANTOINETTE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 LACONIA AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1419
Mailing Address - Country:US
Mailing Address - Phone:914-562-3492
Mailing Address - Fax:
Practice Address - Street 1:2972 LACONIA AVE
Practice Address - Street 2:APT. 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1419
Practice Address - Country:US
Practice Address - Phone:914-562-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325207-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse