Provider Demographics
NPI:1871158949
Name:MACDERMOTT, MORGAN (ND)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:MACDERMOTT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3688 N STONE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4745
Mailing Address - Country:US
Mailing Address - Phone:208-871-0168
Mailing Address - Fax:
Practice Address - Street 1:3688 N STONE CREEK WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4745
Practice Address - Country:US
Practice Address - Phone:208-871-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1050175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath