Provider Demographics
NPI:1265662233
Name:MURRAY, SEAN NOEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:NOEL
Last Name:MURRAY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-225-4310
Mailing Address - Fax:360-225-4339
Practice Address - Street 1:139 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611
Practice Address - Country:US
Practice Address - Phone:360-274-2353
Practice Address - Fax:360-274-7439
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60679799363LF0000X
AZAP3405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072028Medicaid
AZZ160185Medicare PIN