Provider Demographics
NPI:1316656622
Name:MORGAN, ROBERTA RENEE (LPN, BS)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:RENEE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LPN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-2505
Mailing Address - Country:US
Mailing Address - Phone:724-981-9815
Mailing Address - Fax:724-981-2293
Practice Address - Street 1:1914 MERCER AVE
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2505
Practice Address - Country:US
Practice Address - Phone:172-498-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN283974164W00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse