Provider Demographics
NPI:1598020950
Name:MORGAN, SHARONDA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:MARIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32500 CONCORD DR
Mailing Address - Street 2:STE.343
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1100
Mailing Address - Country:US
Mailing Address - Phone:248-588-0512
Mailing Address - Fax:
Practice Address - Street 1:32500 CONCORD DR
Practice Address - Street 2:STE.343
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1100
Practice Address - Country:US
Practice Address - Phone:248-588-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703091461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse