1467419556 NPI number — CAROLANN MARY MORRIS RNPP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467419556 NPI number — CAROLANN MARY MORRIS RNPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
CAROLANN
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUTT
Provider Other First Name:
CAROLANN
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNPP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467419556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 SOCIAL ST
Provider Second Line Business Mailing Address:
THUNDERMIST HEALTH CENTER
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-767-4163
Provider Business Mailing Address Fax Number:
401-767-4165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2ND AVE SBHC
Provider Second Line Business Practice Location Address:
THUNDERMIST HEALTH CENTER WOONSOCKET ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-767-4100
Provider Business Practice Location Address Fax Number:
401-235-6894
Provider Enumeration Date:
05/01/2006

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: 363L00000X , with the licence number:  RNNPP19813 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CM08877 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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