Healthcare Provider Details

I. General information

NPI: 1417278086
Provider Name (Legal Business Name): MICHAEL SHANE MURPHY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

216 14TH AVE SW
SIDNEY MT
59270-3519
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4045
  • Fax: 719-542-0809
Mailing address:
  • Phone: 406-488-2100
  • Fax: 406-488-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0015019-CRNA
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157873
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: