Provider Demographics
NPI:1104462373
Name:MORGAN, SOL STEVENSON
Entity type:Individual
Prefix:
First Name:SOL
Middle Name:STEVENSON
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:27124 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462
Practice Address - Country:US
Practice Address - Phone:225-395-8022
Practice Address - Fax:225-395-8023
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN162118163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN162118OtherRN LICENSE