Healthcare Provider Details

I. General information

NPI: 1427613728
Provider Name (Legal Business Name): SUSANNE MURPHY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 SUMMIT AVE
SAINT PAUL MN
55105-2244
US

IV. Provider business mailing address

70 SW 91ST AVE APT 210
PLANTATION FL
33324-2548
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-7017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number72321
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: