Provider Demographics
NPI:1477694883
Name:MORSE, RICHARD G JR (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:MORSE
Suffix:JR
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 1:989 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45786-6204
Mailing Address - Country:US
Mailing Address - Phone:740-749-0597
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-1580
Practice Address - Fax:740-376-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.09340367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732010Medicaid
OH2732010Medicaid
8239311Medicare PIN
WV3810008570Medicaid