Healthcare Provider Details

I. General information

NPI: 1093625527
Provider Name (Legal Business Name): JOHNNIE MURDOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 N 45TH CT
OMAHA NE
68104-3700
US

IV. Provider business mailing address

3454 N 45TH CT
OMAHA NE
68104-3700
US

V. Phone/Fax

Practice location:
  • Phone: 531-721-6815
  • Fax:
Mailing address:
  • Phone: 531-721-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: