Provider Demographics
NPI:1407681091
Name:MURTHA, JAIMIE DIANE
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:DIANE
Last Name:MURTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 SHELTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2409
Mailing Address - Country:US
Mailing Address - Phone:707-685-6762
Mailing Address - Fax:
Practice Address - Street 1:2460 CLAY BANK RD BLDG 8
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1655
Practice Address - Country:US
Practice Address - Phone:707-701-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program