Healthcare Provider Details

I. General information

NPI: 1477068351
Provider Name (Legal Business Name): MATTHEW COURTLAND MORGAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BROWNS LAKE RD
JACKSON MI
49203-5648
US

IV. Provider business mailing address

5000 BROWNS LAKE RD
JACKSON MI
49203-5648
US

V. Phone/Fax

Practice location:
  • Phone: 517-917-4886
  • Fax:
Mailing address:
  • Phone: 517-917-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number4704287611
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberPENDING
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: