Provider Demographics
NPI:1477063519
Name:MURRIN, LEE VIRGINIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:VIRGINIA
Last Name:MURRIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 E CHAMBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2223
Mailing Address - Country:US
Mailing Address - Phone:815-742-5209
Mailing Address - Fax:
Practice Address - Street 1:305 EAST JOE DRIVE
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310
Practice Address - Country:US
Practice Address - Phone:815-857-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400424155OtherMEDICARE PTAN
IL$$$$$$$$$001Medicaid