Provider Demographics
NPI:1114759578
Name:MORRIS, GRACEFUL IRIS (FNP)
Entity type:Individual
Prefix:
First Name:GRACEFUL
Middle Name:IRIS
Last Name:MORRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GRACEFUL
Other - Middle Name:IRIS
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16901 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-8059
Mailing Address - Country:US
Mailing Address - Phone:208-602-1172
Mailing Address - Fax:
Practice Address - Street 1:1000 S 16TH ST # C
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3403
Practice Address - Country:US
Practice Address - Phone:208-642-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7061372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine