Provider Demographics
NPI:1093320541
Name:MURRAY, POLLY ANN
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:ANN
Last Name:MURRAY
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 1:49231 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43976-9718
Mailing Address - Country:US
Mailing Address - Phone:740-229-0542
Mailing Address - Fax:
Practice Address - Street 1:49499 MURRAY RD
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:OH
Practice Address - Zip Code:43976-9803
Practice Address - Country:US
Practice Address - Phone:740-229-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110054335OtherUNITEDHEALTHCARE