Healthcare Provider Details

I. General information

NPI: 1144545377
Provider Name (Legal Business Name): MEEDEESSA O MORGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEEDEESSA O LIVINGSTON FNP

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 08/16/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL YOKOSUKA JAPAN
FPO AP
96530
US

IV. Provider business mailing address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 810-465-1666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number718455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: