Provider Demographics
NPI:1427764158
Name:MORGAN, OLIVIA SUSANNE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SUSANNE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:SUSANNE
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2206 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5140
Mailing Address - Country:US
Mailing Address - Phone:609-613-1891
Mailing Address - Fax:
Practice Address - Street 1:2206 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5140
Practice Address - Country:US
Practice Address - Phone:609-613-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program