MEDICARE: TONI L. MORNINGSTAR APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	25002.1360	WY

General Provider Information

NPI Number	:	1326445420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI L. MORNINGSTAR APRN

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5027
Fax Number	:	423-339-8362

Provider Business Practice Location Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5027
Fax Number	:	423-339-8362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	12/04/2014

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