Provider Demographics
NPI:1649332834
Name:MURPHY, COLLEEN A (APRN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:MURPHY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-734-4110
Mailing Address - Fax:402-991-5642
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:SUITE103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-734-4110
Practice Address - Fax:402-991-5642
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110179363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068937201Medicaid
NE47006OtherBLUE CROSS BLUE SHIELD
NE10025902800Medicaid
NE37407OtherBLUE CROSS & BLUE SHIELD
NE10025902700Medicaid
NE470548990-13Medicaid
NE470548990-17Medicaid