Provider Demographics
NPI:1497474936
Name:MURPHY ANDRUK, KELLY ANN (IBCLC, LCCE, RYT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MURPHY ANDRUK
Suffix:
Gender:F
Credentials:IBCLC, LCCE, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GERARD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4414
Mailing Address - Country:US
Mailing Address - Phone:860-978-2066
Mailing Address - Fax:
Practice Address - Street 1:2 GERARD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4414
Practice Address - Country:US
Practice Address - Phone:860-978-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CTL-301433174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator