Provider Demographics
NPI:1831333400
Name:MURPHY, MARYANNE (LPN)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOLIN RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3008
Mailing Address - Country:US
Mailing Address - Phone:631-766-9369
Mailing Address - Fax:
Practice Address - Street 1:9 BOLIN RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3008
Practice Address - Country:US
Practice Address - Phone:631-766-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233736-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse