Provider Demographics
NPI:1871065656
Name:NEIDRICK, MORGAN ELAINE (MHS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:ELAINE
Last Name:NEIDRICK
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:MISS
Other - First Name:MORGAN
Other - Middle Name:ELAINE
Other - Last Name:SCHULTINGKEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-0600
Mailing Address - Fax:814-372-4764
Practice Address - Street 1:621 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1413
Practice Address - Country:US
Practice Address - Phone:814-371-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062206363A00000X
OK2981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant