=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881228468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN ELIZABETH GILLENWATER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2020
-----------------------------------------------------
Last Update Date | 02/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4835 POPLAR LEVEL RD STE 110
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40213-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-377-7537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4835 POPLAR LEVEL RD STE 110
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40213-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-377-7537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------