Provider Demographics
NPI:1780338426
Name:MORGAN, MARY F (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:NKETIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 COUGAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6379
Mailing Address - Country:US
Mailing Address - Phone:860-617-5228
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN H STEWARD DRIVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-607-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010359363LA2200X
CT12.010359363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health