Provider Demographics
NPI:1891947826
Name:NICHELSON, MORGAN LYNN
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:LYNN
Last Name:NICHELSON
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 1:930 32ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-5031
Mailing Address - Country:US
Mailing Address - Phone:772-321-2026
Mailing Address - Fax:772-562-6278
Practice Address - Street 1:1281 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3746
Practice Address - Country:US
Practice Address - Phone:772-569-4247
Practice Address - Fax:772-569-4274
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 50698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist