Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209018527 | IL |
NPI | 1003370990 |
---|---|
Provider Name | Randi M Morgan |
First Address | Danville, IL 61832-3752 |
Second Address | Danville, IL 61832-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2019 |
Last Update Date | 25/01/2019 |