Provider Demographics
NPI:1508055385
Name:MURRAY, LYNN ALAN
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ALAN
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E SPRINGMONT DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3526
Mailing Address - Country:US
Mailing Address - Phone:719-547-2805
Mailing Address - Fax:719-647-9780
Practice Address - Street 1:720 E SPRINGMONT DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-3526
Practice Address - Country:US
Practice Address - Phone:719-547-2805
Practice Address - Fax:719-647-9780
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23N143310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility