Provider Demographics
NPI:1871598151
Name:MORTON, DAVID GLENN (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:MORTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6258
Mailing Address - Country:US
Mailing Address - Phone:616-485-6882
Mailing Address - Fax:616-977-9573
Practice Address - Street 1:2261 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6258
Practice Address - Country:US
Practice Address - Phone:616-485-6882
Practice Address - Fax:616-977-9573
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704146772367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered