Provider Demographics
NPI:1235390113
Name:MORGAN, JEAN P (FNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:P
Last Name:MORGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:2987 VT ROUTE 22A
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:VT
Practice Address - Zip Code:05770-9728
Practice Address - Country:US
Practice Address - Phone:802-897-7000
Practice Address - Fax:802-897-7718
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0016394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015157Medicaid
NY03836959Medicaid
000692801Medicare PIN