Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN.CNP.0029758 | OH |
NPI | 1083385603 |
---|---|
Provider Name | Mrs. Lacey Morgan |
First Address | Moundsville, WV 26041-1651 |
Second Address | Moundsville, WV 26041-1293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 23/09/2021 |