Provider Demographics
NPI:1083098792
Name:MOLER, MORGAN BICKERSTAFF (RN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BICKERSTAFF
Last Name:MOLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:CROFT
Other - Last Name:BICKERSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:780 ALBANY ST
Mailing Address - Street 2:BOSTON HEALTHCARE FOR THE HOMELESS PROGRAM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2524
Mailing Address - Country:US
Mailing Address - Phone:857-654-1000
Mailing Address - Fax:
Practice Address - Street 1:780 ALBANY STREET
Practice Address - Street 2:BOSTON HEALTHCARE FOR THE HOMELESS PROGRAM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2524
Practice Address - Country:US
Practice Address - Phone:857-654-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse