Provider Demographics
NPI:1578233920
Name:HEROLD, MORGAN JANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:JANE
Last Name:HEROLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3064
Mailing Address - Country:US
Mailing Address - Phone:814-877-4110
Mailing Address - Fax:814-835-6699
Practice Address - Street 1:2861 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3064
Practice Address - Country:US
Practice Address - Phone:814-877-4110
Practice Address - Fax:814-835-6699
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005807363A00000X
PAMA062854363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty