Healthcare Provider Details

I. General information

NPI: 1366788721
Provider Name (Legal Business Name): PHLICA ANN MORGAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5837
US

IV. Provider business mailing address

3436 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5837
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7777
  • Fax: 505-462-7729
Mailing address:
  • Phone: 505-462-7777
  • Fax: 505-462-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR41607
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: