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General NPI Number Information
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NPI Number | 1093356396
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Entity Type | Individual
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Provider Name | MORGAN MARIE MONAHAN
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 501 E CHICAGO BLVD
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City | TECUMSEH
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State | MI
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Zip | 49286-1515
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Country | US
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Telephone | 313-948-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 506 HICKORY RIDGE DR
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City | TECUMSEH
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State | MI
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Zip | 49286-1082
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Country | US
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Telephone | 517-759-2229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006440RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010006
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License Number State | MI
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