Provider Demographics
NPI:1033219688
Name:MURPHY, TARA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2356
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:541-342-6088
Practice Address - Street 1:160 NW FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1086
Practice Address - Country:US
Practice Address - Phone:541-474-0057
Practice Address - Fax:541-474-0638
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN128072367A00000X
AZAP2023367A00000X
OR201391426NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672953Medicaid
AZ891590Medicaid
OR500672953Medicaid