1962487108 NPI number — SUSAN ANNE MORGAN CNM, FNP

Table of content: SUSAN ANNE MORGAN CNM, FNP (NPI 1962487108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962487108 NPI number — SUSAN ANNE MORGAN CNM, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
SUSAN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN
Provider Other First Name:
ANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962487108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 THOMPSON RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOS BAY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97420-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-269-8538
Provider Business Mailing Address Fax Number:
541-267-5083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1775 THOMPSON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOS BAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97420-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-269-8538
Provider Business Practice Location Address Fax Number:
541-267-5083
Provider Enumeration Date:
12/09/2005

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: 363L00000X , with the licence number:  200250115NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 077010025N5 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 076815 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407812365 . This is a "NBMC NPI NUMBER-GROUP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 03-15-2007 . This is a "NBMC TERMINATION DATE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 93-0635514 . This is a "GROUP TAX ID FOR BILLING" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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