Provider Demographics
NPI:1427736453
Name:O'HARA, MORGAN NICOLE (RDN, CSR)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:O'HARA
Suffix:
Gender:F
Credentials:RDN, CSR
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:NICOLE
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 HALF MOON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1809
Mailing Address - Country:US
Mailing Address - Phone:315-382-1725
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:315-382-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133VN1005X
86040889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal