Provider Demographics
NPI:1649368218
Name:MORGAN, ROSANN (PA-C)
Entity type:Individual
Prefix:
First Name:ROSANN
Middle Name:
Last Name:MORGAN
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 1:113 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-9707
Mailing Address - Country:US
Mailing Address - Phone:360-985-7754
Mailing Address - Fax:360-496-5093
Practice Address - Street 1:745 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564-9004
Practice Address - Country:US
Practice Address - Phone:360-983-8990
Practice Address - Fax:360-983-8995
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649368218Medicaid
WAG8917892OtherMEDICARE PTAN
WA363A00000XOtherTAXONOMY