Healthcare Provider Details

I. General information

NPI: 1053883777
Provider Name (Legal Business Name): AMANDA KATHLEEN MORGAN LGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY STE 401
DOVER NH
03820-5933
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-0092
  • Fax:
Mailing address:
  • Phone: 603-740-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0139
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: