Provider Demographics
NPI:1285053876
Name:MORRIS, JESSICA MICHELLE (CNM)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:DORN/GORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2112 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5317
Mailing Address - Country:US
Mailing Address - Phone:309-794-7088
Mailing Address - Fax:309-558-2815
Practice Address - Street 1:2112 25TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5317
Practice Address - Country:US
Practice Address - Phone:309-794-7088
Practice Address - Fax:309-558-2815
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011458367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife