Provider Demographics
NPI:1669664454
Name:MURPHY, MICHELLE MYERS (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MYERS
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MURPHY
Other - Last Name:GAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2726 66TH PL SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8337
Mailing Address - Country:US
Mailing Address - Phone:509-778-2054
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174564363LF0000X
WAAP30007825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily