Healthcare Provider Details

I. General information

NPI: 1265377634
Provider Name (Legal Business Name): DESIRAE NICOLE MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

IV. Provider business mailing address

2250 GABLE RD APT 704
SAINT HELENS OR
97051-3028
US

V. Phone/Fax

Practice location:
  • Phone: 971-225-8614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: