Provider Demographics
NPI:1447869326
Name:MORGAN, EMMA NICOLE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:NICOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 SUNNYSLOPE RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9142
Mailing Address - Country:US
Mailing Address - Phone:360-536-6316
Mailing Address - Fax:
Practice Address - Street 1:6614 SUNNYSLOPE RD SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9142
Practice Address - Country:US
Practice Address - Phone:360-536-6316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60968304390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program