Basic Information
Provider Information
NPI: 1346514924
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORGAN
FirstName: MICHELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 406 N SPRING ST
Address2:  
City: MCMINNVILLE
State: TN
PostalCode: 371102134
CountryCode: US
TelephoneNumber: 9315071212
FaxNumber: 9315071217
Practice Location
Address1: 920 UNIVERSITY ST
Address2:  
City: MARTIN
State: TN
PostalCode: 382371605
CountryCode: US
TelephoneNumber: 7315885829
FaxNumber: 7315885834
Other Information
ProviderEnumerationDate: 02/29/2012
LastUpdateDate: 02/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X157119TNY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home