Healthcare Provider Details

I. General information

NPI: 1649375098
Provider Name (Legal Business Name): AMANDA V MORGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 LINN ST
ALLEGAN MI
49010-1595
US

IV. Provider business mailing address

5717 OAKLAND DR STE A
PORTAGE MI
49024-1116
US

V. Phone/Fax

Practice location:
  • Phone: 269-686-5800
  • Fax: 269-686-5896
Mailing address:
  • Phone: 269-323-4473
  • Fax: 269-324-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004617
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: