Provider Demographics
NPI:1962006650
Name:BETT, MORGAN M
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:M
Last Name:BETT
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 1:7218 W NORTH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1854
Mailing Address - Country:US
Mailing Address - Phone:920-838-3998
Mailing Address - Fax:
Practice Address - Street 1:3070 N 51ST ST STE 506
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1663
Practice Address - Country:US
Practice Address - Phone:414-447-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86077608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered