Provider Demographics
NPI:1417556127
Name:MURRAY, VALEDA A
Entity Type:Individual
Prefix:
First Name:VALEDA
Middle Name:A
Last Name:MURRAY
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 1:2205 JACKSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL
Mailing Address - State:ID
Mailing Address - Zip Code:83612-5244
Mailing Address - Country:US
Mailing Address - Phone:208-812-2211
Mailing Address - Fax:
Practice Address - Street 1:2205 JACKSON CREEK RD
Practice Address - Street 2:
Practice Address - City:COUNCIL
Practice Address - State:ID
Practice Address - Zip Code:83612-5244
Practice Address - Country:US
Practice Address - Phone:208-812-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID122364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health