Basic Information
| Provider Information | |||||||||
| NPI: | 1871142927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWITT | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 NORTHWEST ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448111204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193574858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 W HIGH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.