1396086245 NPI number — COLLEEN S MURRAY CNP

Table of content: COLLEEN S MURRAY CNP (NPI 1396086245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396086245 NPI number — COLLEEN S MURRAY CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
COLLEEN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396086245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401S DON ROSER DR F1-2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-4567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-521-4848
Provider Business Mailing Address Fax Number:
575-522-1798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1626 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 503
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-3770
Provider Business Practice Location Address Fax Number:
915-313-0487
Provider Enumeration Date:
03/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  692262 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "692262" identifier . This identifiers is of the category "OTHER".
  • Identifier: 692262 . This is a "692262" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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