Provider Demographics
NPI:1679230262
Name:MURI, ETHAN (CRNP)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:MURI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-2455
Mailing Address - Country:US
Mailing Address - Phone:814-765-6625
Mailing Address - Fax:814-503-8553
Practice Address - Street 1:15 N FRONT ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2455
Practice Address - Country:US
Practice Address - Phone:814-765-6625
Practice Address - Fax:814-503-8553
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily