Provider Demographics
NPI:1386450856
Name:MURPHY, HEATHER SUE (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 S 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2941
Mailing Address - Country:US
Mailing Address - Phone:315-598-7400
Mailing Address - Fax:315-598-7505
Practice Address - Street 1:522 S 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2941
Practice Address - Country:US
Practice Address - Phone:315-598-7400
Practice Address - Fax:315-598-7505
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619815163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health