Healthcare Provider Details

I. General information

NPI: 1376656603
Provider Name (Legal Business Name): DONNA S MURRAY FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29306 GOVERNOR GEORGE C PEERY HWY
NORTH TAZEWELL VA
24630-0218
US

IV. Provider business mailing address

PO BOX 218
NORTH TAZEWELL VA
24630-0218
US

V. Phone/Fax

Practice location:
  • Phone: 276-979-0030
  • Fax: 276-979-0031
Mailing address:
  • Phone: 276-979-0030
  • Fax: 276-979-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024073730
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: