Provider Demographics
NPI:1932607348
Name:JOHNSON, MORGAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:CASSADAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14718-9681
Mailing Address - Country:US
Mailing Address - Phone:716-720-6446
Mailing Address - Fax:
Practice Address - Street 1:7141 NELSON RD
Practice Address - Street 2:
Practice Address - City:CASSADAGA
Practice Address - State:NY
Practice Address - Zip Code:14718-9681
Practice Address - Country:US
Practice Address - Phone:716-720-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326234164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse