Healthcare Provider Details

I. General information

NPI: 1265662233
Provider Name (Legal Business Name): SEAN NOEL MURRAY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 1ST AVE SW
CASTLE ROCK WA
98611
US

IV. Provider business mailing address

1057 12TH AVE
LONGVIEW WA
98632-2509
US

V. Phone/Fax

Practice location:
  • Phone: 360-274-2353
  • Fax: 360-274-7439
Mailing address:
  • Phone: 360-225-4310
  • Fax: 360-225-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60679799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: