Provider Demographics
NPI:1740625276
Name:MURPHY, LIESL KATHERINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LIESL
Middle Name:KATHERINE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LIESL
Other - Middle Name:KATHERINE
Other - Last Name:MESSERLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3325 N RACINE AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3232
Mailing Address - Country:US
Mailing Address - Phone:773-941-2042
Mailing Address - Fax:
Practice Address - Street 1:201 E HURON ST STE 11-140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2968
Practice Address - Country:US
Practice Address - Phone:312-926-8636
Practice Address - Fax:312-695-1903
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004660363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical