Provider Demographics
NPI:1669422283
Name:MORGAN, MARILYN KAY (NP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 CLARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8917
Mailing Address - Country:US
Mailing Address - Phone:810-229-7846
Mailing Address - Fax:810-229-7846
Practice Address - Street 1:3650 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4806
Practice Address - Country:US
Practice Address - Phone:815-877-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322787363L00000X, 363LG0600X
MO2002026665363L00000X
MI4704145479363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00249347OtherRAILROAD MEDICARE
MI104750072Medicaid
MO427206909Medicaid
ILP00250027OtherRAILROAD MEDICARE N IL
ILP00256645OtherRAILROAD MEDICARE S IL
KSY06000003Medicare PIN
MOY15000002Medicare PIN
OHMONP27921Medicare PIN
MIN69350005Medicare PIN
ILP00256645OtherRAILROAD MEDICARE S IL
MO427206909Medicaid
ILP00250027OtherRAILROAD MEDICARE N IL
KS111393001Medicare PIN