Provider Demographics
NPI:1871964023
Name:MORSON, GWYNDOLEN (NP)
Entity type:Individual
Prefix:
First Name:GWYNDOLEN
Middle Name:
Last Name:MORSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GWYNDOLEN
Other - Middle Name:
Other - Last Name:VICARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:401 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3754
Mailing Address - Country:US
Mailing Address - Phone:317-926-1507
Mailing Address - Fax:317-926-1508
Practice Address - Street 1:401 E 34TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3754
Practice Address - Country:US
Practice Address - Phone:317-926-1507
Practice Address - Fax:317-926-1508
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28203742A163W00000X
IN71005921A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse