Provider Demographics
NPI:1053909804
Name:DILLON-VAN IWAARDEN, MORGAN E (PA-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:DILLON-VAN IWAARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:E
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:901 PATIENTS FIRST DR STE 3200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-239-7727
Mailing Address - Fax:636-239-5021
Practice Address - Street 1:901 PATIENTS FIRST DR STE 3200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-239-7727
Practice Address - Fax:636-239-5021
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022032224363AM0700X, 363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program