Provider Demographics
NPI:1417184839
Name:MURPHY, KARETHA LACRYSTAL
Entity Type:Individual
Prefix:
First Name:KARETHA
Middle Name:LACRYSTAL
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 CHURCH ST
Mailing Address - Street 2:APARTMENT 250
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8953
Mailing Address - Country:US
Mailing Address - Phone:909-489-2171
Mailing Address - Fax:
Practice Address - Street 1:10730 CHURCH ST
Practice Address - Street 2:APARTMENT 250
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8953
Practice Address - Country:US
Practice Address - Phone:909-489-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN208136164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse