MEDICARE: JENNY RUSSO MURPHY FNTP

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1205504057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY RUSSO MURPHY FNTP

Provider Business Mailing Address
First Line	:	26 GROVE ST
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-2849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 GROVE ST
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-2849
Country	:	US
Telephone Number	:	617-784-8943
Fax Number	:

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

Provider Enumeration Date	:	09/04/2021
Last Update Date	:	09/04/2021

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