Provider Demographics
NPI:1538385398
Name:MURPHY, BANINA MICHELLE (INDEPENDANT PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:BANINA
Middle Name:MICHELLE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:INDEPENDANT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CORNELL WOODS DR W APT F
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3751
Mailing Address - Country:US
Mailing Address - Phone:937-270-6710
Mailing Address - Fax:937-949-8195
Practice Address - Street 1:3900 CORNELL WOODS DR W APT F
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3751
Practice Address - Country:US
Practice Address - Phone:937-270-6710
Practice Address - Fax:937-949-8195
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104387Medicaid