Basic Information
Provider Information | |||||||||
NPI: | 1962510594 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORGAN | ||||||||
FirstName: | WENDE | ||||||||
MiddleName: | SUE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 71 ALLEN ST | ||||||||
Address2: | SUITE 403 | ||||||||
City: | RUTLAND | ||||||||
State: | VT | ||||||||
PostalCode: | 057014570 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8027724414 | ||||||||
FaxNumber: | 8027727973 | ||||||||
Practice Location | |||||||||
Address1: | 215 STRATTON RD | ||||||||
Address2: |   | ||||||||
City: | RUTLAND | ||||||||
State: | VT | ||||||||
PostalCode: | 057014621 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8027733386 | ||||||||
FaxNumber: | 8027734578 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/25/2006 | ||||||||
LastUpdateDate: | 04/27/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1010021207 | VT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 043346203 | 01 |   | CIGNA | OTHER | ONP2022 | 05 | VT |   | MEDICAID | 04173819 | 05 | NY |   | MEDICAID | 48416 | 01 | VT | BCBS | OTHER |