Provider Demographics
NPI:1386421709
Name:STEWART, MORGAN DEE NETTLES (WHNP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:DEE NETTLES
Last Name:STEWART
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:DEE
Other - Last Name:NETTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12713 FRIAR TUCK RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8745
Mailing Address - Country:US
Mailing Address - Phone:530-277-2341
Mailing Address - Fax:
Practice Address - Street 1:844 OLD TUNNEL RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8524
Practice Address - Country:US
Practice Address - Phone:530-273-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95154597163W00000X
CA95027118363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse