Provider Demographics
NPI:1629817911
Name:WIDENHOUSE, MORGAN SCHWEERS
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:SCHWEERS
Last Name:WIDENHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:MORGAN
Other - Last Name:SCHWEERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1336 COLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3902
Mailing Address - Country:US
Mailing Address - Phone:843-822-8649
Mailing Address - Fax:
Practice Address - Street 1:851 LEONARD FULGHUM DR STE 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3793
Practice Address - Country:US
Practice Address - Phone:843-856-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC259633163WX0003X, 163W00000X
SC29106363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No163W00000XNursing Service ProvidersRegistered Nurse