Provider Demographics
NPI:1215950852
Name:MURRAY, DOREEN W (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:W
Last Name:MURRAY
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 ANDORA DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9657
Mailing Address - Country:US
Mailing Address - Phone:734-929-2945
Mailing Address - Fax:
Practice Address - Street 1:3126 ANDORA DR
Practice Address - Street 2:
Practice Address - City:SUPERIOR TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48198-9657
Practice Address - Country:US
Practice Address - Phone:734-929-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001710367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004215291Medicaid
CT004215291Medicaid