Healthcare Provider Details

I. General information

NPI: 1093280331
Provider Name (Legal Business Name): MORGAN DUKE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 VILLAGE PROFESSIONAL DR
OPELIKA AL
36801-2380
US

IV. Provider business mailing address

2570 VILLAGE PROFESSIONAL DR
OPELIKA AL
36801-2380
US

V. Phone/Fax

Practice location:
  • Phone: 334-203-1917
  • Fax: 334-203-1918
Mailing address:
  • Phone: 334-203-1917
  • Fax: 334-203-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-141504
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: