Provider Demographics
NPI:1447018833
Name:MORRIS, MATTHEW WAYNE
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WAYNE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N UGSTAD RD
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55810-1829
Mailing Address - Country:US
Mailing Address - Phone:218-341-7582
Mailing Address - Fax:
Practice Address - Street 1:1122 S 54TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1734
Practice Address - Country:US
Practice Address - Phone:218-341-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program