Provider Demographics
NPI:1427537448
Name:MURRAY, BREANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-6328
Mailing Address - Country:US
Mailing Address - Phone:815-289-0049
Mailing Address - Fax:
Practice Address - Street 1:1211 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1099
Practice Address - Country:US
Practice Address - Phone:360-532-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant