Provider Demographics
NPI:1215602628
Name:MURPHY, SHANNON DOUGLAS (AGACNP)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:DOUGLAS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
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Mailing Address - Street 1:2960 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-867-3241
Practice Address - Street 1:2960 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-421-3494
Practice Address - Fax:513-867-3241
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029482363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care