Provider Demographics
NPI:1619232287
Name:MURPHY FAMILY, SPORTS, AND WELLNESS
Entity Type:Organization
Organization Name:MURPHY FAMILY, SPORTS, AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MYERS
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-778-2054
Mailing Address - Street 1:PO BOX 98886
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8886
Mailing Address - Country:US
Mailing Address - Phone:253-584-3577
Mailing Address - Fax:253-584-8916
Practice Address - Street 1:4905 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-581-3075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007825364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty