Provider Demographics
NPI:1962620799
Name:MORGENSTERN, DANIEL RAY (ARNP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAY
Last Name:MORGENSTERN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5736
Practice Address - Country:US
Practice Address - Phone:360-486-6710
Practice Address - Fax:360-705-0614
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003910363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28986Medicare UPIN
GAB24715Medicare PIN
500021125OtherRAILROAD
1659MOOtherREGENCE BS
A013OtherTRICARE
S28986Medicare UPIN
OR268749Medicaid
WAAP30003910OtherSTATE LICENCE