Provider Demographics
NPI:1932349800
Name:MCMURRY, MONICA NICOLE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:NICOLE
Last Name:MCMURRY
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 1:2700 W POWELL BLVD APT O3115
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6540
Mailing Address - Country:US
Mailing Address - Phone:503-954-4406
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2031
Practice Address - Country:US
Practice Address - Phone:503-813-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200510988CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide