Provider Demographics
NPI:1104125004
Name:MORELLO, JAN KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:KATHERINE
Last Name:MORELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 ANSELMO LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1101
Mailing Address - Country:US
Mailing Address - Phone:225-768-6419
Mailing Address - Fax:
Practice Address - Street 1:7850 ANSELMO LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1101
Practice Address - Country:US
Practice Address - Phone:225-768-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207576208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2151037Medicaid