Healthcare Provider Details

I. General information

NPI: 1922860089
Provider Name (Legal Business Name): ANNETTE YVETTE MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 CARPENTER ST
MEMPHIS TN
38108-1704
US

IV. Provider business mailing address

1575 CARPENTER ST
MEMPHIS TN
38108-1704
US

V. Phone/Fax

Practice location:
  • Phone: 901-830-2907
  • Fax:
Mailing address:
  • Phone: 901-830-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number062722-PW
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number41025
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number062722-PWECW20324
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: