Provider Demographics
NPI:1588792584
Name:MURRAY, TRACY O (LPN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:O
Last Name:MURRAY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER
Mailing Address - State:LA
Mailing Address - Zip Code:70395-4110
Mailing Address - Country:US
Mailing Address - Phone:985-446-7332
Mailing Address - Fax:
Practice Address - Street 1:2632 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LABADIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70372-2045
Practice Address - Country:US
Practice Address - Phone:985-526-1699
Practice Address - Fax:985-526-1699
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA840944164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse