Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 209023125 | IL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209023125 | IL |
NPI | 1407435241 |
---|---|
Provider Name | Benjamin Allen Morelock |
First Address | Quincy, IL 62301-2834 |
Second Address | Quincy, IL 62301-2834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |