Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 2701188264 | MI |
NPI | 1003443334 |
---|---|
Provider Name | Denitia Lynnice Morris |
First Address | Eastpointe, MI 48021-1453 |
Second Address | Eastpointe, MI 48021-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/03/2020 |