Provider Demographics
NPI:1588797294
Name:MORGAN, DEBORAH L (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:KENTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47951-1379
Mailing Address - Country:US
Mailing Address - Phone:219-474-5464
Mailing Address - Fax:219-474-3603
Practice Address - Street 1:303 N 7TH ST
Practice Address - Street 2:
Practice Address - City:KENTLAND
Practice Address - State:IN
Practice Address - Zip Code:47951-1379
Practice Address - Country:US
Practice Address - Phone:219-474-5464
Practice Address - Fax:219-474-3603
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000059A363LF0000X
IL209-003629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71000059AMedicaid
IN71000059AMedicaid