Provider Demographics
NPI:1437640562
Name:MORGAN, RHONDALYN
Entity Type:Individual
Prefix:
First Name:RHONDALYN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ETRANSPORT, LLC
Mailing Address - Street 2:241 CHESTNUT ROYAL ROAD
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522
Mailing Address - Country:US
Mailing Address - Phone:434-238-4367
Mailing Address - Fax:434-352-9269
Practice Address - Street 1:ETRANSPORT, LLC
Practice Address - Street 2:241 CHESTNUT ROYAL ROAD
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522
Practice Address - Country:US
Practice Address - Phone:434-238-4367
Practice Address - Fax:434-352-9269
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMC18000087PS172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA82-3448041Medicaid