Provider Demographics
NPI:1477068351
Name:MORGAN, MATTHEW COURTLAND (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:COURTLAND
Last Name:MORGAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BROWNS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5648
Mailing Address - Country:US
Mailing Address - Phone:517-917-4886
Mailing Address - Fax:
Practice Address - Street 1:5000 BROWNS LAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5648
Practice Address - Country:US
Practice Address - Phone:517-917-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287611163WE0003X
MIPENDING363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency