Provider Demographics
NPI:1972194140
Name:PETERSON, MORGAN RENAY (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RENAY
Last Name:PETERSON
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 1:1606 CARMODY CT STE 202
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8566
Mailing Address - Country:US
Mailing Address - Phone:724-933-1500
Mailing Address - Fax:
Practice Address - Street 1:1606 CARMODY CT STE 202
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8566
Practice Address - Country:US
Practice Address - Phone:724-933-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant