MEDICARE: VALEDA A MURRAY

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	364SH0200X	Home Health Clinical Nurse Specialist	122	ID

General Provider Information

NPI Number	:	1417556127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALEDA A MURRAY

Provider Business Mailing Address
First Line	:	2205 JACKSON CREEK RD
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-5244
Country	:	US
Telephone Number	:	208-812-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 JACKSON CREEK RD
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-5244
Country	:	US
Telephone Number	:	208-812-2211
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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Directions to “ VALEDA A MURRAY ” Practice Location

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