Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | APO-197 | AZ |
NPI | 1093707077 |
---|---|
Provider Name | Mrs. Edie Jay Morgan |
First Address | Prescott, AZ 86301-1673 |
Second Address | Prescott, AZ 86305-7166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 30/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
831041 | (05) | AZ |
AZ0146110 | BLUE CROSS/BLUE SHIELD (01) | AZ |
Q05765 | (02) | AZ |