Provider Demographics
NPI:1194144360
Name:MORGAN, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
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 1:1760 E RIVER RD
Mailing Address - Street 2:#350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:1620 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2624
Practice Address - Country:US
Practice Address - Phone:520-624-7445
Practice Address - Fax:520-623-6145
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ904818Medicaid
AZ904818Medicaid