Basic Information
| Provider Information | |||||||||
| NPI: | 1396268850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 MONARCHY LN | ||||||||
| Address2: | |||||||||
| City: | WHITELAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461849252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175071732 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 E COUNTY LINE RD STE B | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174976333 | ||||||||
| FaxNumber: | 3174976334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 71007300A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 300004436 | 05 | IN | MEDICAID |