Provider Demographics
NPI:1134829856
Name:MERRILL-WINOWIECKI, MORGAN J (NP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:J
Last Name:MERRILL-WINOWIECKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:J
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22230 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1593
Mailing Address - Country:US
Mailing Address - Phone:517-404-9555
Mailing Address - Fax:
Practice Address - Street 1:22230 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1593
Practice Address - Country:US
Practice Address - Phone:517-404-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner