Provider Demographics
NPI:1831926690
Name:MCMURTRY, EDEN MARIE
Entity type:Individual
Prefix:MS
First Name:EDEN
Middle Name:MARIE
Last Name:MCMURTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 116TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:KILLDEER
Mailing Address - State:ND
Mailing Address - Zip Code:58640-9327
Mailing Address - Country:US
Mailing Address - Phone:509-723-8907
Mailing Address - Fax:
Practice Address - Street 1:497 116TH AVE SW
Practice Address - Street 2:
Practice Address - City:KILLDEER
Practice Address - State:ND
Practice Address - Zip Code:58640-9327
Practice Address - Country:US
Practice Address - Phone:701-204-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant