MEDICARE: MS. BREDA ODWYER MURPHY APN-FNP BC

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	163W00000X	Registered Nurse	041.387329	IL
2	363L00000X	Nurse Practitioner	209.016733	IL

General Provider Information

NPI Number	:	1619420809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BREDA ODWYER MURPHY APN-FNP BC

Provider Business Mailing Address
First Line	:	6336 W 60TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4222
Country	:	US
Telephone Number	:	773-255-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	6336 W 60TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4222
Country	:	US
Telephone Number	:	773-255-7167
Fax Number	:

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	11/22/2017

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