Provider Demographics
NPI:1700169547
Name:MURPHY, LINDSAY MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:MARIE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 N VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-2272
Mailing Address - Country:US
Mailing Address - Phone:909-234-5420
Mailing Address - Fax:
Practice Address - Street 1:8891 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1618
Practice Address - Country:US
Practice Address - Phone:909-297-3361
Practice Address - Fax:909-621-1397
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant