Healthcare Provider Details

I. General information

NPI: 1477237428
Provider Name (Legal Business Name): STEPHANIE L MORGAN BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 GRAND AVE APT 31
DES MOINES IA
50312-4127
US

IV. Provider business mailing address

1429 SUNRISE MANOR WAY
BOISE ID
83713-7956
US

V. Phone/Fax

Practice location:
  • Phone: 208-891-2625
  • Fax:
Mailing address:
  • Phone: 208-891-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number33690
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number33690
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: