Provider Demographics
NPI:1306464193
Name:MORRELL, CYNTHIA DIANE (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:MORRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALDER LN
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2568
Mailing Address - Country:US
Mailing Address - Phone:978-857-7286
Mailing Address - Fax:
Practice Address - Street 1:28 LEVESQUE DR STE 9
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2073
Practice Address - Country:US
Practice Address - Phone:978-857-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN152323163W00000X
MEMT6247163WM1400X
MERN73183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)