Provider Demographics
NPI:1720313802
Name:MURRAY, NINA NACACIA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:NACACIA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021B MCCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3136
Mailing Address - Country:US
Mailing Address - Phone:509-989-6670
Mailing Address - Fax:
Practice Address - Street 1:104 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1902
Practice Address - Country:US
Practice Address - Phone:509-989-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60086572172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist