Healthcare Provider Details

I. General information

NPI: 1730644568
Provider Name (Legal Business Name): MS. ASHLEY NICOLE MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE MORGAN MS ASHLEY MORGAN

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/03/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 E 79TH ST
CHICAGO IL
60619
US

IV. Provider business mailing address

PO BOX 497631
CHICAGO IL
60649-0122
US

V. Phone/Fax

Practice location:
  • Phone: 773-469-0386
  • Fax:
Mailing address:
  • Phone: 773-469-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number011294332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: