Provider Demographics
NPI:1306067798
Name:MORRIS, VERONICA G (LPN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:G
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 1:207 CONSTANCE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5227
Mailing Address - Country:US
Mailing Address - Phone:662-240-1310
Mailing Address - Fax:662-244-5844
Practice Address - Street 1:207 CONSTANCE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5227
Practice Address - Country:US
Practice Address - Phone:662-240-1310
Practice Address - Fax:662-244-5844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP317428164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770533Medicaid