Provider Demographics
NPI:1861422800
Name:MORGAN, LINDA LEE (LM)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1956
Mailing Address - Country:US
Mailing Address - Phone:509-326-4366
Mailing Address - Fax:509-328-9266
Practice Address - Street 1:4505 ROAD K NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9095
Practice Address - Country:US
Practice Address - Phone:509-994-4850
Practice Address - Fax:509-766-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 000174176B00000X
WA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8066417Medicaid
WA7069024Medicaid
WA8066417Medicaid