Provider Demographics
NPI:1750317376
Name:MURPHY, ELLEN T (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:T
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-0011
Practice Address - Fax:207-883-2586
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEAP081511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME263070099Medicaid
NH30340878Medicaid
ME263070099Medicaid
MEP00690145Medicare PIN
MENP260801Medicare PIN
MEP12263Medicare UPIN
MENP260802Medicare PIN
NH30340878Medicaid
MENP260804Medicare PIN
MEP00928497Medicare PIN