1154879971 NPI number — MRS. KRYSTYNA NICOLE MORCOS AU.D.

Table of content: MRS. KRYSTYNA NICOLE MORCOS AU.D. (NPI 1154879971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154879971 NPI number — MRS. KRYSTYNA NICOLE MORCOS AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORCOS
Provider First Name:
KRYSTYNA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAHAM
Provider Other First Name:
KRYSTYNA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154879971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1133 21ST ST. NW
Provider Second Line Business Mailing Address:
BUILDING 2, SUITE 501
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-416-2093
Provider Business Mailing Address Fax Number:
202-785-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1133 21ST ST. NW
Provider Second Line Business Practice Location Address:
BUILDING 2, SUITE 501
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-416-2093
Provider Business Practice Location Address Fax Number:
202-785-5040
Provider Enumeration Date:
09/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AUD000171 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)