1003382938 NPI number — MS. EDWINA G WALLACE MORROW L.P.C.

Table of content: MS. EDWINA G WALLACE MORROW L.P.C. (NPI 1003382938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003382938 NPI number — MS. EDWINA G WALLACE MORROW L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLACE MORROW
Provider First Name:
EDWINA
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLACE
Provider Other First Name:
EDWINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003382938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 MORGAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-245-1142
Provider Business Mailing Address Fax Number:
269-966-2844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 S. SHORE DR.
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49014-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-964-0153
Provider Business Practice Location Address Fax Number:
855-877-5812
Provider Enumeration Date:
10/18/2018

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: 101YP2500X , with the licence number:  6401222814 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 6401011732 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6401011732 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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