Provider Demographics
NPI:1043607740
Name:MURDOCH, PETRA
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 POLLOCK DR
Mailing Address - Street 2:
Mailing Address - City:BRINNON
Mailing Address - State:WA
Mailing Address - Zip Code:98320-9555
Mailing Address - Country:US
Mailing Address - Phone:541-359-7969
Mailing Address - Fax:
Practice Address - Street 1:677 POLLOCK DR
Practice Address - Street 2:
Practice Address - City:BRINNON
Practice Address - State:WA
Practice Address - Zip Code:98320-9555
Practice Address - Country:US
Practice Address - Phone:541-359-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist