Provider Demographics
NPI:1942553417
Name:MORRIS, JEANETTE K (LAC)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9751 N GOVERNMENT WAY
Mailing Address - Street 2:STE 1
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9645
Mailing Address - Country:US
Mailing Address - Phone:208-660-6777
Mailing Address - Fax:208-772-7737
Practice Address - Street 1:9751 N GOVERNMENT WAY
Practice Address - Street 2:STE 1
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9645
Practice Address - Country:US
Practice Address - Phone:208-660-6777
Practice Address - Fax:208-772-7737
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-206171100000X
WAAC 3032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist