Provider Demographics
NPI:1912117920
Name:MORGAN, JOHN ALAN (LVN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74930 COUNTRY CLUB DR
Mailing Address - Street 2:# 540-20
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1980
Mailing Address - Country:US
Mailing Address - Phone:760-221-6559
Mailing Address - Fax:
Practice Address - Street 1:74930 COUNTRY CLUB DR
Practice Address - Street 2:# 540-20
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1980
Practice Address - Country:US
Practice Address - Phone:760-221-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN166401164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN001230Medicaid
CAEPS012630Medicaid