Provider Demographics
NPI:1508404880
Name:PEARSON, MORGAN ALEXIS (RDN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ALEXIS
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W CAMROSE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2712
Mailing Address - Country:US
Mailing Address - Phone:208-731-6281
Mailing Address - Fax:
Practice Address - Street 1:3301 W CAMROSE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2712
Practice Address - Country:US
Practice Address - Phone:208-731-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered