Provider Demographics
NPI:1114564127
Name:MURRAY, DEVON (RD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 CAMBRIDGE AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-4022
Mailing Address - Country:US
Mailing Address - Phone:717-856-6158
Mailing Address - Fax:
Practice Address - Street 1:3726 CAMBRIDGE AVE APT 18
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-4022
Practice Address - Country:US
Practice Address - Phone:717-856-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO86118707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
6544OtherN/A