Provider Demographics
NPI:1134224827
Name:MORRIS, THERESA D (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:D
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CUMBERLAND ST
Mailing Address - Street 2:EXECUTIVE PLAZA 4TH FLOOR
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201
Mailing Address - Country:US
Mailing Address - Phone:276-645-4758
Mailing Address - Fax:276-669-9093
Practice Address - Street 1:510 CUMBERLAND ST
Practice Address - Street 2:EXECUTIVE PLAZA 4TH FLOOR
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:276-645-4758
Practice Address - Fax:276-669-9093
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002064195164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse