Healthcare Provider Details

I. General information

NPI: 1134567282
Provider Name (Legal Business Name): TOD MICHAEL MORRISON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 150
LOGAN UT
84341-2549
US

IV. Provider business mailing address

740 S WOODRUFF AVE
IDAHO FALLS ID
83401-5285
US

V. Phone/Fax

Practice location:
  • Phone: 435-915-4465
  • Fax: 435-799-3664
Mailing address:
  • Phone: 208-542-9111
  • Fax: 208-542-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5129925-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: