Healthcare Provider Details

I. General information

NPI: 1528609211
Provider Name (Legal Business Name): STEPHANIE MARIE MORTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 S CLEVELAND MASSILLON RD
NORTON OH
44203-5611
US

IV. Provider business mailing address

100 PEACH ST STE 200
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-6643
  • Fax: 330-753-3465
Mailing address:
  • Phone: 814-877-7733
  • Fax: 814-456-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: