Healthcare Provider Details

I. General information

NPI: 1992747018
Provider Name (Legal Business Name): BRENDA JO MURRAY MSN, CFNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 CALLE CACIQUE
SANTA FE NM
87505-4909
US

IV. Provider business mailing address

2259 CALLE CACIQUE
SANTA FE NM
87505-4909
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8904
  • Fax: 505-984-9969
Mailing address:
  • Phone: 505-984-8904
  • Fax: 505-984-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number178933
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: