Healthcare Provider Details

I. General information

NPI: 1629627872
Provider Name (Legal Business Name): RICHARD MORROW RN-BSN, AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 POMONA DR
GREENSBORO NC
27407-1616
US

IV. Provider business mailing address

36 1ST AVE
CHARLESTOWN MA
02129-4557
US

V. Phone/Fax

Practice location:
  • Phone: 336-299-0000
  • Fax: 336-299-2335
Mailing address:
  • Phone: 860-942-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2320616
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5012614
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: