Provider Demographics
NPI:1851914550
Name:MURCHISON, DESTINI
Entity Type:Individual
Prefix:
First Name:DESTINI
Middle Name:
Last Name:MURCHISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E EDGEWOOD BLVD APT 111
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5916
Mailing Address - Country:US
Mailing Address - Phone:517-249-5594
Mailing Address - Fax:
Practice Address - Street 1:513 E EDGEWOOD BLVD APT 111
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5916
Practice Address - Country:US
Practice Address - Phone:517-249-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health