Healthcare Provider Details

I. General information

NPI: 1437381209
Provider Name (Legal Business Name): MARY M. MORGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 WOODSAGE AVE, BLDG A
MERRIDIAN ID
83642
US

IV. Provider business mailing address

1160 WOODSAGE AVENUE BLDG A
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-906-1231
  • Fax: 208-906-1232
Mailing address:
  • Phone: 208-906-1231
  • Fax: 208-906-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number20407A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-937A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: