Provider Demographics
NPI:1710661715
Name:BAZYK, MORGAN RAY
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RAY
Last Name:BAZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9463
Mailing Address - Country:US
Mailing Address - Phone:802-688-3356
Mailing Address - Fax:
Practice Address - Street 1:34 BONNET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-8920
Practice Address - Country:US
Practice Address - Phone:802-768-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0136271PROV363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner