Provider Demographics
NPI:1639172240
Name:MURRAY, STACEY-JO (APRN)
Entity Type:Individual
Prefix:
First Name:STACEY-JO
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SECOND ST
Mailing Address - Street 2:UNIT C6
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2213
Mailing Address - Country:US
Mailing Address - Phone:203-249-5881
Mailing Address - Fax:
Practice Address - Street 1:PRO HEALTH PARTNERS
Practice Address - Street 2:9 BISHOP RD
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06487
Practice Address - Country:US
Practice Address - Phone:203-521-7543
Practice Address - Fax:203-643-2000
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004244886Medicaid
CT004244886Medicaid
CTP92176Medicare UPIN