Provider Demographics
NPI:1669775524
Name:MURPHY, VANTONE VAN (LPN)
Entity type:Individual
Prefix:MR
First Name:VANTONE
Middle Name:VAN
Last Name:MURPHY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:VANTONE
Other - Middle Name:MURPHY
Other - Last Name:HIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 TACOMA AVE S STE 305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1903
Mailing Address - Country:US
Mailing Address - Phone:253-396-5800
Mailing Address - Fax:253-396-5172
Practice Address - Street 1:1305 TACOMA AVE S STE 305
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1903
Practice Address - Country:US
Practice Address - Phone:253-396-5800
Practice Address - Fax:253-396-5172
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00043422164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse