Provider Demographics
NPI:1376578898
Name:MCMURTRY, MYRALEN (NP)
Entity Type:Individual
Prefix:MS
First Name:MYRALEN
Middle Name:
Last Name:MCMURTRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17535 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4809
Mailing Address - Country:US
Mailing Address - Phone:708-957-9308
Mailing Address - Fax:708-957-9308
Practice Address - Street 1:9718 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1007
Practice Address - Country:US
Practice Address - Phone:708-293-8132
Practice Address - Fax:708-293-8110
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL93032Medicare UPIN