Healthcare Provider Details

I. General information

NPI: 1831501204
Provider Name (Legal Business Name): MORGAN KUCALA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20029 JANUARY ST
BIG LAKE MN
55309-4829
US

IV. Provider business mailing address

20029 JANUARY ST
BIG LAKE MN
55309-4829
US

V. Phone/Fax

Practice location:
  • Phone: 712-260-2672
  • Fax:
Mailing address:
  • Phone: 712-260-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10921
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: