Provider Demographics
NPI:1700086402
Name:MURPHY, ROSA L (CNA)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1144
Mailing Address - Country:US
Mailing Address - Phone:219-886-1671
Mailing Address - Fax:
Practice Address - Street 1:324 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1144
Practice Address - Country:US
Practice Address - Phone:219-886-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN44-03-00-04419374U00000X
IN44-01-05-07059376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide