Provider Demographics
NPI:1083218267
Name:MURPHY, NATHAN WILLIAM VIII
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:MURPHY
Suffix:VIII
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HORSE SHOE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAYNOKA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8139
Mailing Address - Country:US
Mailing Address - Phone:937-510-5468
Mailing Address - Fax:
Practice Address - Street 1:170 HORSE SHOE DR
Practice Address - Street 2:
Practice Address - City:LAKE WAYNOKA
Practice Address - State:OH
Practice Address - Zip Code:45171-8139
Practice Address - Country:US
Practice Address - Phone:937-510-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245197Medicaid