Healthcare Provider Details

I. General information

NPI: 1376631325
Provider Name (Legal Business Name): SUSAN M MURPHY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1209
WARM SPRINGS OR
97761-1209
US

IV. Provider business mailing address

PO BOX 1209
WARM SPRINGS OR
97761-1209
US

V. Phone/Fax

Practice location:
  • Phone: 541-553-1196
  • Fax: 541-553-2135
Mailing address:
  • Phone: 541-553-1196
  • Fax: 541-553-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number170596
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number170596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: