Provider Demographics
NPI:1598149908
Name:DE KLEINE, MORGAN ELIZABETH (CNM, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:DE KLEINE
Suffix:
Gender:F
Credentials:CNM, FNP-BC
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ELIZABETH
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 LIGHTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3824
Mailing Address - Country:US
Mailing Address - Phone:574-533-0348
Mailing Address - Fax:574-533-0277
Practice Address - Street 1:1111 LIGHTHOUSE LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3824
Practice Address - Country:US
Practice Address - Phone:574-533-0348
Practice Address - Fax:574-533-0277
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005590A207VG0400X, 363LF0000X
IN09000266A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife