Provider Demographics
NPI:1073351649
Name:CHURCHWELL, MORGAN MICHELLE (CNP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:MICHELLE
Last Name:CHURCHWELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 WILSON SHARPSVILLE RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9381
Mailing Address - Country:US
Mailing Address - Phone:330-646-2365
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORY LN
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9415
Practice Address - Country:US
Practice Address - Phone:330-527-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF06241210363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner