Provider Demographics
NPI:1306182217
Name:BERCAW, MORGAN ASHLEY (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:ASHLEY
Last Name:BERCAW
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 STOUGH RD
Mailing Address - Street 2:
Mailing Address - City:TIRO
Mailing Address - State:OH
Mailing Address - Zip Code:44887-9752
Mailing Address - Country:US
Mailing Address - Phone:419-961-3910
Mailing Address - Fax:
Practice Address - Street 1:6063 STOUGH RD
Practice Address - Street 2:
Practice Address - City:TIRO
Practice Address - State:OH
Practice Address - Zip Code:44887-9752
Practice Address - Country:US
Practice Address - Phone:419-961-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH384744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse