Provider Demographics
NPI:1508953043
Name:MORGENROTH, NONNA O (MD)
Entity type:Individual
Prefix:
First Name:NONNA
Middle Name:O
Last Name:MORGENROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NONNA
Other - Middle Name:O
Other - Last Name:TERESHONOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:1909 214TH ST SE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-488-4988
Practice Address - Fax:425-488-4993
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008403207Q00000X
WAMD60011530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8522732Medicaid
WA8522732Medicaid
WA8522732Medicaid
WAG8877209Medicare PIN
WABM9483760OtherDEA