Basic Information
Provider Information
NPI: 1639140627
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIEB-MORGAN
FirstName: ERIN
MiddleName: JEAN
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4046
Address2:  
City: SPRINGFIELD
State: MO
PostalCode: 658084046
CountryCode: US
TelephoneNumber: 4172728911
FaxNumber:  
Practice Location
Address1: 1000 E PRIMROSE
Address2: #300
City: SPRINGFIELD
State: MO
PostalCode: 658077315
CountryCode: US
TelephoneNumber: 4172693700
FaxNumber: 4172693707
Other Information
ProviderEnumerationDate: 01/30/2006
LastUpdateDate: 07/02/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X2013021220MOY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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