Healthcare Provider Details

I. General information

NPI: 1235390113
Provider Name (Legal Business Name): JEAN P MORGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2987 VT ROUTE 22A
SHOREHAM VT
05770-9728
US

IV. Provider business mailing address

71 ALLEN ST SUITE #403
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-897-7000
  • Fax: 802-897-7718
Mailing address:
  • Phone: 802-772-4414
  • Fax: 802-772-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0016394
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: