Healthcare Provider Details

I. General information

NPI: 1972248219
Provider Name (Legal Business Name): ELISA MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 03/05/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 WRIGHTSVILLE AVE STE 120
WILMINGTON NC
28403-6256
US

IV. Provider business mailing address

113 DAPPLE CT APT 305
WILMINGTON NC
28403-1644
US

V. Phone/Fax

Practice location:
  • Phone: 910-679-8385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30001026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: