Healthcare Provider Details

I. General information

NPI: 1477694883
Provider Name (Legal Business Name): RICHARD G MORSE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

989 SMITH RD
WATERFORD OH
45786-6204
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-1580
  • Fax: 740-376-1940
Mailing address:
  • Phone: 740-749-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.09340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: