Healthcare Provider Details

I. General information

NPI: 1225885486
Provider Name (Legal Business Name): MORGAN OPASANYAH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16015 BLACK WILLOW LN
FISHERS IN
46040-8818
US

IV. Provider business mailing address

16015 BLACK WILLOW LN
FISHERS IN
46040-8818
US

V. Phone/Fax

Practice location:
  • Phone: 317-987-0900
  • Fax:
Mailing address:
  • Phone: 317-987-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28288411A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: