Provider Demographics
NPI:1376656603
Name:MURRAY, DONNA S (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:S
Last Name:MURRAY
Suffix:
Gender:F
Credentials:FNPC
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 218
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630-0218
Mailing Address - Country:US
Mailing Address - Phone:276-979-0030
Mailing Address - Fax:276-979-0031
Practice Address - Street 1:29306 GOVERNOR GEORGE C PEERY HWY
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630-0218
Practice Address - Country:US
Practice Address - Phone:276-979-0030
Practice Address - Fax:276-979-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024073730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010023157Medicaid
VAP00163274OtherRAILROAD
VA190000632Medicare ID - Type Unspecified
P74515Medicare UPIN