Provider Demographics
NPI:1619420809
Name:ODWYER MURPHY, BREDA (APN-FNP BC)
Entity Type:Individual
Prefix:MS
First Name:BREDA
Middle Name:
Last Name:ODWYER MURPHY
Suffix:
Gender:F
Credentials:APN-FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4222
Mailing Address - Country:US
Mailing Address - Phone:773-255-7167
Mailing Address - Fax:
Practice Address - Street 1:6336 W 60TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4222
Practice Address - Country:US
Practice Address - Phone:773-255-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.387329163W00000X
IL209.016733363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse