Provider Demographics
NPI:1629615109
Name:MURPHY, MARCIA ANTOINETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANTOINETTE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18424 KLINGER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1718
Mailing Address - Country:US
Mailing Address - Phone:313-768-4414
Mailing Address - Fax:
Practice Address - Street 1:18424 KLINGER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1718
Practice Address - Country:US
Practice Address - Phone:313-768-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner