Healthcare Provider Details

I. General information

NPI: 1457255804
Provider Name (Legal Business Name): MORGAN JEAN BOARDWINE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

IV. Provider business mailing address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-4755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number1-190445
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1-190445
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: