MEDICARE: MISS MICHAELA MARIE MURPHY AGPCNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F308481-1	NY

General Provider Information

NPI Number	:	1023520038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHAELA MARIE MURPHY AGPCNP

Provider Business Mailing Address
First Line	:	104 UNION AVE STE 901
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-1845
Country	:	US
Telephone Number	:	315-703-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 UNION AVE STE 901
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-1845
Country	:	US
Telephone Number	:	315-703-5102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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