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General NPI Number Information
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NPI Number | 1003164898
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Entity Type | Individual
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Provider Name | MORGAN TIUS GARRIOTT MSN, APRN, CNP, FNP
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Gender | Male
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2325 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-542-7021
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Fax | 208-542-7371
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Provider Business Mailing Address
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Address Line | 754 N SKYLINE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-2662
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Country | US
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Telephone | 208-403-2951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1217A
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License Number State | ID
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