Individual
ALEX MORGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 313-0924
Mailing address
PO BOX 1627, IDAHO FALLS, ID 83403-1627
(208) 552-8778
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
67662
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
67662
ID
367500000X
Certified Registered Nurse Anesthetist
PENDING
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114503745
—
ID
Enumeration date
03/23/2021
Last updated
07/16/2021
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