Provider Demographics
NPI:1184724015
Name:MURPHY, JASON WILLIAM (CRNA APNP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WILLIAM
Last Name:MURPHY
Suffix:
Gender:M
Credentials:CRNA APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3526
Mailing Address - Country:US
Mailing Address - Phone:920-433-8328
Mailing Address - Fax:920-431-3082
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-433-8328
Practice Address - Fax:920-431-3082
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130141-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44312000Medicaid
WI44312000Medicaid
0041-21143Medicare ID - Type Unspecified