Provider Demographics
NPI:1891013686
Name:MURPHY, MARY H (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1948
Mailing Address - Country:US
Mailing Address - Phone:419-433-6179
Mailing Address - Fax:
Practice Address - Street 1:410 SENECA AVE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1948
Practice Address - Country:US
Practice Address - Phone:419-433-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD. 3498133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered