Provider Demographics
NPI:1992750574
Name:MURRAY, LYNETTE C (CRNA)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:C
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3453
Mailing Address - Country:US
Mailing Address - Phone:870-421-5177
Mailing Address - Fax:
Practice Address - Street 1:1185 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2093
Practice Address - Country:US
Practice Address - Phone:860-423-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01339367500000X
ARR52311367500000X
CT4121367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR52311OtherRN LICENSE