Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | WV |
NPI | 1114528148 |
---|---|
Provider Name | Jordan Renee Morrison |
First Address | Bridgeport, WV 26330-9147 |
Second Address | Bridgeport, WV 26330-9147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 09/11/2020 |