Healthcare Provider Details

I. General information

NPI: 1689839896
Provider Name (Legal Business Name): LYNN MAKI MURPHY RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BODART ST
GREEN BAY WI
54301-4923
US

IV. Provider business mailing address

2961 ANCESTOR WAY
GREEN BAY WI
54313-8069
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-9773
  • Fax:
Mailing address:
  • Phone: 920-434-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number341433
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number3414-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: