Provider Demographics
NPI:1881215820
Name:DANIELSON, MORGAN GOODHEW (FNP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:GOODHEW
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LEA
Other - Last Name:GOODHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59257 HIGH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-4114
Mailing Address - Country:US
Mailing Address - Phone:574-993-8081
Mailing Address - Fax:
Practice Address - Street 1:1615 WINSTED DR STE 4
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4673
Practice Address - Country:US
Practice Address - Phone:574-533-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210057A163W00000X
IN71010159A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse