Provider Demographics
NPI:1245978659
Name:MURRY, NIKI
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:MURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 RANDOLPH ARCH APT 415
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4461
Mailing Address - Country:US
Mailing Address - Phone:757-367-2251
Mailing Address - Fax:
Practice Address - Street 1:2004 RANDOLPH ARCH APT 415
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4461
Practice Address - Country:US
Practice Address - Phone:757-367-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-222748251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health