=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952910226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA WALTON MURRY BSN,RN-CSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2020
-----------------------------------------------------
Last Update Date | 07/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13909 FLORIDA BLVD
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70754-6340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-686-7044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12435 LAKELAND DR
-----------------------------------------------------
City | WALKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70785-8207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-931-0571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | RN101779
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------