Healthcare Provider Details

I. General information

NPI: 1508953043
Provider Name (Legal Business Name): NONNA O MORGENROTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NONNA O TERESHONOK M.D.

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE SUITE 110
BOTHELL WA
98021-4412
US

IV. Provider business mailing address

PO BOX 34036
SEATTLE WA
98124-1036
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-4988
  • Fax: 425-488-4993
Mailing address:
  • Phone: 425-899-3292
  • Fax: 425-899-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML20008403
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60011530
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8522732
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: