Provider Demographics
NPI:1538794508
Name:MURPHY, ELLEN (CPM, LM)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63779 YOUNGS PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:CONSTANTINE
Mailing Address - State:MI
Mailing Address - Zip Code:49042-9605
Mailing Address - Country:US
Mailing Address - Phone:269-435-2679
Mailing Address - Fax:
Practice Address - Street 1:63779 YOUNGS PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:CONSTANTINE
Practice Address - State:MI
Practice Address - Zip Code:49042-9605
Practice Address - Country:US
Practice Address - Phone:269-435-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7602000009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty