Basic Information
| Provider Information | |||||||||
| NPI: | 1619159613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORSE | ||||||||
| FirstName: | TIM | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PATTERSON BLVD | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259388050 | ||||||||
| FaxNumber: | 9259389040 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 PATTERSON BLVD | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259388050 | ||||||||
| FaxNumber: | 9259388040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | 562073 | CA | Y | Nursing Service Providers | Registered Nurse | Administrator |
No ID Information.