Provider Demographics
NPI:1871620369
Name:MURPHY, PATRICIA JANE (RN PHN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 MEWUK DR
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-9316
Mailing Address - Country:US
Mailing Address - Phone:530-573-0642
Mailing Address - Fax:
Practice Address - Street 1:1360 JOHNSON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8201
Practice Address - Country:US
Practice Address - Phone:530-573-3049
Practice Address - Fax:530-543-6819
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429250364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health