Provider Demographics
NPI:1780740894
Name:MURTHA, ROBIN CHASE (MSN, APRN)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:CHASE
Last Name:MURTHA
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FARMVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2514
Mailing Address - Country:US
Mailing Address - Phone:203-458-8607
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:SUITE 223
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-5812
Practice Address - Fax:203-375-6027
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002748363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247286-00Medicaid