Healthcare Provider Details

I. General information

NPI: 1801403928
Provider Name (Legal Business Name): MORGAN LEWIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

PO BOX 6005 DEPT 196
INDIANAPOLIS IN
46206-6005
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6262
  • Fax:
Mailing address:
  • Phone: 866-282-7905
  • Fax: 800-731-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28258491A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: