Provider Demographics
NPI:1376864447
Name:MURPHY, COLLETTE KAY
Entity type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:KAY
Last Name:MURPHY
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 1:10302 COUNTY ROAD 147
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7057
Mailing Address - Country:US
Mailing Address - Phone:218-841-8682
Mailing Address - Fax:218-844-6500
Practice Address - Street 1:10302 COUNTY ROAD 147
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7057
Practice Address - Country:US
Practice Address - Phone:218-841-8682
Practice Address - Fax:218-844-6500
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26-4231828171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376864447OtherCLEANING AND HOME MAINTENANCE SERVICES