Provider Demographics
NPI:1457918187
Name:PAVON, MORGAN NICHOLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICHOLE
Last Name:PAVON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1355
Mailing Address - Country:US
Mailing Address - Phone:515-720-2192
Mailing Address - Fax:
Practice Address - Street 1:108 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1760
Practice Address - Country:US
Practice Address - Phone:515-967-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered