Provider Demographics
NPI:1073983466
Name:FIACCATO, MORGAN MONTEZ (FNP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:MONTEZ
Last Name:FIACCATO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:MONTEZ
Other - Last Name:FIACCATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:36950 DUNSTABLE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5430
Mailing Address - Country:US
Mailing Address - Phone:480-645-4090
Mailing Address - Fax:
Practice Address - Street 1:9328 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2098
Practice Address - Country:US
Practice Address - Phone:602-266-8463
Practice Address - Fax:602-266-0122
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272573163W00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine