Provider Demographics
NPI:1790061448
Name:NIXON, MORGAN D (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:NIXON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LAKE COOK RD
Mailing Address - Street 2:STE 280
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5255
Mailing Address - Country:US
Mailing Address - Phone:847-480-0004
Mailing Address - Fax:847-480-8707
Practice Address - Street 1:707 LAKE COOK RD STE 280
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5255
Practice Address - Country:US
Practice Address - Phone:847-480-0004
Practice Address - Fax:847-480-8707
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant