Healthcare Provider Details

I. General information

NPI: 1912838194
Provider Name (Legal Business Name): MORGAN JEAN BORDEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

11616 TERRILL RIDGE DR
DAVIDSON NC
28036-7730
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number357674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: