Provider Demographics
NPI:1659536662
Name:MORGAN, MICHELLE SUZANNE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4236
Mailing Address - Country:US
Mailing Address - Phone:207-921-5970
Mailing Address - Fax:207-921-5310
Practice Address - Street 1:4 GLEN COVE DR STE 102
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4236
Practice Address - Country:US
Practice Address - Phone:207-921-5970
Practice Address - Fax:207-921-5310
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP171119363LA2200X
AZAP3067363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health