Healthcare Provider Details

I. General information

NPI: 1407037195
Provider Name (Legal Business Name): MRS. JULIA MURDOCH SELF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEDICAL PARK RD STE 200
MOORESVILLE NC
28117-8579
US

IV. Provider business mailing address

PO BOX 1845
STATESVILLE NC
28687-1845
US

V. Phone/Fax

Practice location:
  • Phone: 704-696-2085
  • Fax: 704-658-9328
Mailing address:
  • Phone: 704-873-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number50163732
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: