MEDICARE: ROXANNE MARKOV MORGAN RN, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	5437	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PNP 5437	OTHER	CA	PED NURSE PRAC LICENCE #
2	348252	OTHER	CA	RN LICENSE

General Provider Information

NPI Number	:	1225236698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE MARKOV MORGAN RN, CPNP

Provider Business Mailing Address
First Line	:	154 TRAFFIC WAY
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3341
Country	:	US
Telephone Number	:	805-473-3262
Fax Number	:	805-473-3707

Provider Business Practice Location Address
First Line	:	154 TRAFFIC WAY
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3341
Country	:	US
Telephone Number	:	805-473-3262
Fax Number	:	805-473-3707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	07/30/2007

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