Healthcare Provider Details

I. General information

NPI: 1083116073
Provider Name (Legal Business Name): PAIGE DEEAUNDRA MURPHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date: 10/13/2020
Reactivation Date: 10/28/2020

III. Provider practice location address

399 E MAIN ST
COLUMBUS OH
43215-5384
US

IV. Provider business mailing address

DEPARTMENT 781629
DETROIT MI
48278-1629
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8550
  • Fax: 614-355-8593
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS2005291
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: