Provider Demographics
NPI:1699547760
Name:FRIED, MORGAN DANIELLE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:DANIELLE
Last Name:FRIED
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SHERMAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3711
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:224-271-4870
Practice Address - Street 1:1630 SHERMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3711
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:224-271-4870
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041444961163W00000X
IL209028690363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily