Healthcare Provider Details

I. General information

NPI: 1669705554
Provider Name (Legal Business Name): SALLY MORTON R.N.C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD STE 2500
NEWBURGH IN
47630-8968
US

IV. Provider business mailing address

3700 WASHINGTON AVE STE 1100
EVANSVILLE IN
47750
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-0045
  • Fax: 812-471-0120
Mailing address:
  • Phone: 812-471-0045
  • Fax: 812-476-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number70000170A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: