Provider Demographics
NPI:1306909783
Name:MORGAN, SUSAN DESTINY (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DESTINY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3355
Mailing Address - Country:US
Mailing Address - Phone:530-690-2820
Mailing Address - Fax:530-690-2801
Practice Address - Street 1:706 PEACH ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3355
Practice Address - Country:US
Practice Address - Phone:530-690-2820
Practice Address - Fax:559-690-2801
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692442163W00000X
CA16997363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse