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General NPI Number Information
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NPI Number | 1295230407
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Entity Type | Individual
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Provider Name | MORGAN LIVELY DO
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 225 CHURCH ST
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City | STOUGHTON
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State | WI
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Zip | 53589-1801
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Country | US
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Telephone | 608-877-2777
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Fax | 608-877-2774
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Provider Business Mailing Address
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Address Line | 225 CHURCH ST
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City | STOUGHTON
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State | WI
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Zip | 53589-1801
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Country | US
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Telephone | 608-877-2777
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Fax | 608-877-2774
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 72523-21
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License Number State | WI
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