Provider Demographics
NPI:1871953323
Name:MORGAN, MARIANNE DIANA (RDH)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:DIANA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23100 NE 152ND PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-7201
Mailing Address - Country:US
Mailing Address - Phone:206-834-5294
Mailing Address - Fax:
Practice Address - Street 1:23100 NE 152ND PL
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-7201
Practice Address - Country:US
Practice Address - Phone:206-588-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60390425376K00000X, 376K00000X
WADH00005250124Q00000X
WAMR60655885172V00000X
WAMR60645031172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide
Yes124Q00000XDental ProvidersDental Hygienist