Healthcare Provider Details

I. General information

NPI: 1962127621
Provider Name (Legal Business Name): TESA SUZANNE MORROW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4599
US

IV. Provider business mailing address

8830 W BRADBURY DR
BOISE ID
83704-4301
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1083
Mailing address:
  • Phone: 208-407-0302
  • Fax: 208-422-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number11508
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: