Provider Demographics
NPI:1629212881
Name:MORGAN, VANESSA (L AC, NCCA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:L AC, NCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1448
Mailing Address - Country:US
Mailing Address - Phone:970-403-4150
Mailing Address - Fax:
Practice Address - Street 1:129 E 32ND ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4232
Practice Address - Country:US
Practice Address - Phone:970-403-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist