Provider Demographics
NPI:1891791190
Name:MURRAY-KOSS, MARLA L (APNP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:L
Last Name:MURRAY-KOSS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 COUNTY ROAD PH STE 100
Mailing Address - Street 2:P.O. BOX 783
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8440
Mailing Address - Country:US
Mailing Address - Phone:608-781-2225
Mailing Address - Fax:608-781-2495
Practice Address - Street 1:1202 COUNTY ROAD PH STE 100
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8440
Practice Address - Country:US
Practice Address - Phone:608-781-2225
Practice Address - Fax:608-781-2495
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41255800Medicaid
Q35610Medicare UPIN
WI41255800Medicaid