Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP017133 | PA |
NPI | 1003353673 |
---|---|
Provider Name | Mr. Jacob Andrew Morrison |
First Address | Hershey, PA 17033-1324 |
Second Address | Hershey, PA 17033-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 13/10/2021 |