=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598352890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE ELIZABETH MURRAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2020
-----------------------------------------------------
Last Update Date | 12/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 COLE ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-710-8903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 COLE ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-710-8903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | T60263277
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------