Healthcare Provider Details

I. General information

NPI: 1811211543
Provider Name (Legal Business Name): MILTINA C MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1614
US

IV. Provider business mailing address

1111 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1614
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-5501
  • Fax: 505-255-9971
Mailing address:
  • Phone: 505-255-5501
  • Fax: 505-255-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: