Provider Demographics
NPI:1710611470
Name:MURPHY, JACQUELYN MARY (AGACNP)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELYN
Middle Name:MARY
Last Name:MURPHY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 KNOLLWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1237
Mailing Address - Country:US
Mailing Address - Phone:248-872-5930
Mailing Address - Fax:
Practice Address - Street 1:61 KNOLLWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1237
Practice Address - Country:US
Practice Address - Phone:248-872-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361607363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care