Provider Demographics
NPI:1275996928
Name:MURDOCK, MARK (R N)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-0006
Mailing Address - Country:US
Mailing Address - Phone:219-405-6338
Mailing Address - Fax:866-656-4532
Practice Address - Street 1:1353 SAGER RD
Practice Address - Street 2:37
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6454
Practice Address - Country:US
Practice Address - Phone:219-405-6338
Practice Address - Fax:866-656-4532
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157795A163W00000X
IL041337622163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse