Provider Demographics
NPI:1497243505
Name:MURRAY, TEMETRIUS NICOLE
Entity Type:Individual
Prefix:
First Name:TEMETRIUS
Middle Name:NICOLE
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 1:140 HIGH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1435
Mailing Address - Country:US
Mailing Address - Phone:413-495-1500
Mailing Address - Fax:
Practice Address - Street 1:178 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2254
Practice Address - Country:US
Practice Address - Phone:413-629-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker