Provider Demographics
NPI:1679798318
Name:MURPHY, MICHAELA RUTH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RUTH
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 BROUGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7203
Mailing Address - Country:US
Mailing Address - Phone:215-284-0620
Mailing Address - Fax:
Practice Address - Street 1:6901 MARKET ST
Practice Address - Street 2:CVS/MINUTECLINIC
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9727
Practice Address - Country:US
Practice Address - Phone:910-395-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant