Provider Demographics
NPI:1366226789
Name:WONDRAK, MORGAN ALEXANDRA
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ALEXANDRA
Last Name:WONDRAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ALEXANDRA
Other - Last Name:POSTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8140 N CAMINO DE LA VIOLA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1152
Mailing Address - Country:US
Mailing Address - Phone:520-955-3342
Mailing Address - Fax:
Practice Address - Street 1:8140 N CAMINO DE LA VIOLA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1152
Practice Address - Country:US
Practice Address - Phone:520-955-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ237995163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine