Provider Demographics
NPI:1760226583
Name:MURPHY, MICHAL DALE
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:DALE
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 NAVARRE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3301
Mailing Address - Country:US
Mailing Address - Phone:419-291-1420
Mailing Address - Fax:
Practice Address - Street 1:3316 NAVARRE AVE STE F
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3301
Practice Address - Country:US
Practice Address - Phone:419-291-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038409363L00000X
MI4704307755163W00000X
OH360748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse