Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R081714 | MD |
NPI | 1023056207 |
---|---|
Provider Name | Mrs. Bodil Lynn Morris |
First Address | Takoma Park, MD 20912-6386 |
Second Address | Laurel, MD 20707-6386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
306796300 | (05) | FL |
P67566 | (02) | |
Y063K | BCBS (01) | FL |