Provider Demographics
NPI:1205413341
Name:MORDEN, JUSTINE (LPN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MORDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1644
Mailing Address - Country:US
Mailing Address - Phone:810-662-8033
Mailing Address - Fax:
Practice Address - Street 1:9036 E M 36
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-8147
Practice Address - Country:US
Practice Address - Phone:734-449-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703122925164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703122925OtherLPN-CONTINUE EDUCATION COURSE PURPOSES