Healthcare Provider Details

I. General information

NPI: 1285020610
Provider Name (Legal Business Name): MORGAN HAGERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN PETERS

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-5008
  • Fax: 937-641-5003
Mailing address:
  • Phone: 937-641-5008
  • Fax: 937-641-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number399362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: