Provider Demographics
NPI:1124083019
Name:MORRIS, MARIE L (FNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:603 WEST FIRST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-342-3939
Mailing Address - Fax:315-349-0129
Practice Address - Street 1:448 COUNTY ROUTE 1A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-349-0215
Practice Address - Fax:315-349-0276
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P11081Medicare UPIN