Healthcare Provider Details

I. General information

NPI: 1902391030
Provider Name (Legal Business Name): ANDREA RAE MORGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA RAE PISCHKE

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 05/26/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 MDG 5955 ZEAMER AVE
JBER AK
99506
US

IV. Provider business mailing address

673 MDG 5955 ZEAMER AVE
JBER AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-8303
  • Fax:
Mailing address:
  • Phone: 907-580-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8506493-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: