Provider Demographics
NPI:1114530672
Name:RUPP, MORGAN G (CNP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:G
Last Name:RUPP
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EDGEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5801
Mailing Address - Country:US
Mailing Address - Phone:740-914-4178
Mailing Address - Fax:740-386-2640
Practice Address - Street 1:1107 S MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4703
Practice Address - Country:US
Practice Address - Phone:419-806-4222
Practice Address - Fax:419-806-4350
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty