Provider Demographics
NPI:1386069284
Name:CONNIE MORRIS, CRNP, LLC
Entity type:Organization
Organization Name:CONNIE MORRIS, CRNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-362-7249
Mailing Address - Street 1:13106 WINCHESTER RD SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6035
Mailing Address - Country:US
Mailing Address - Phone:240-362-7249
Mailing Address - Fax:240-362-7285
Practice Address - Street 1:13106 WINCHESTER RD SW STE 100
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6035
Practice Address - Country:US
Practice Address - Phone:240-362-7249
Practice Address - Fax:240-362-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR088399261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230293ZB9FOtherMEDICARE