Healthcare Provider Details

I. General information

NPI: 1336037142
Provider Name (Legal Business Name): MS. AL-NISA MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHARLESTON DR
SICKLERVILLE NJ
08081-2315
US

IV. Provider business mailing address

33 CHARLESTON DR
SICKLERVILLE NJ
08081-2315
US

V. Phone/Fax

Practice location:
  • Phone: 609-738-7168
  • Fax:
Mailing address:
  • Phone: 609-738-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number345310
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: