Provider Demographics
NPI:1962127621
Name:MORROW, TESA SUZANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TESA
Middle Name:SUZANNE
Last Name:MORROW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 W BRADBURY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4301
Mailing Address - Country:US
Mailing Address - Phone:208-407-0302
Mailing Address - Fax:208-422-1083
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4599
Practice Address - Country:US
Practice Address - Phone:208-422-1000
Practice Address - Fax:208-422-1083
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11508164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse