Provider Demographics
NPI:1013799253
Name:MURPHY, BRIANNA CECELIA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CECELIA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W BLACKHAWK ST APT 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2559
Mailing Address - Country:US
Mailing Address - Phone:608-443-6955
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 650
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8684
Practice Address - Country:US
Practice Address - Phone:773-377-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.010017363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant