Healthcare Provider Details

I. General information

NPI: 1376479287
Provider Name (Legal Business Name): JONATHA A MORVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 WALNUT ST
LIVINGSTON NJ
07039-2513
US

IV. Provider business mailing address

93 GODWIN AVE
ELMWOOD PARK NJ
07407-2817
US

V. Phone/Fax

Practice location:
  • Phone: 973-462-0496
  • Fax:
Mailing address:
  • Phone: 973-941-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR18188600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: