1861472813 NPI number — MICHELLE A MORGAN CRNA

Table of content: MICHELLE A MORGAN CRNA (NPI 1861472813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861472813 NPI number — MICHELLE A MORGAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
MICHELLE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861472813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 S. SERVICE RD.
Provider Second Line Business Mailing Address:
STE 350
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3347
Provider Business Mailing Address Fax Number:
516-945-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FAIRFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16346-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-877-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN226501L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019678450002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019678450003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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