Provider Demographics
NPI:1043967003
Name:MORGANTE, JACQUELINE LORRAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LORRAINE
Last Name:MORGANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:LORRAINE
Other - Last Name:MORGANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:32397 CONCORD DR APT F
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1204
Mailing Address - Country:US
Mailing Address - Phone:248-242-4108
Mailing Address - Fax:
Practice Address - Street 1:32397 CONCORD DR APT F
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1204
Practice Address - Country:US
Practice Address - Phone:248-242-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309352163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice