Provider Demographics
NPI:1750479259
Name:MURRAY, JACQUELYN V (NP, ND)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:V
Last Name:MURRAY
Suffix:
Gender:F
Credentials:NP, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-6119 HOOMAMA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-7953
Mailing Address - Country:US
Mailing Address - Phone:808-326-9755
Mailing Address - Fax:
Practice Address - Street 1:75-166 KALANI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1857
Practice Address - Country:US
Practice Address - Phone:808-329-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4216363LA2200X
HI738363LA2200X
CO3542364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIQ57467Medicare UPIN
HIH101073Medicare PIN