Basic Information
| Provider Information | |||||||||
| NPI: | 1588737464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 SW AMBERWOOD LOOP | ||||||||
| Address2: | APARTMENT # 102 | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320256979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044522168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 S MARION AVE | ||||||||
| Address2: | NUTRITION AND FOOD SERVICE (120) | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320255808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867456312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 03/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 916707 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 136A00000X | 916707 | N | Dietary & Nutritional Service Providers | Dietetic Technician, Registered |
No ID Information.