Provider Demographics
NPI:1972580058
Name:MURPHY, MICHELLE M (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:550 MAIN STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7575
Mailing Address - Fax:612-454-2430
Practice Address - Street 1:6043 HUDSON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-925-8200
Practice Address - Fax:651-925-8201
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2020-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR134646-2363LA2200X
MNR1346462363LP0808X
MN2803363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972580058Medicaid