Provider Demographics
NPI:1801437629
Name:MURRAY, CARMEN LATRICE (APRN)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LATRICE
Last Name:MURRAY
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 1:14301 GRANERY LN
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3755
Mailing Address - Country:US
Mailing Address - Phone:240-539-7929
Mailing Address - Fax:
Practice Address - Street 1:401 POST OFFICE RD STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2738
Practice Address - Country:US
Practice Address - Phone:240-539-7929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041392796163W00000X
IL209027139363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1740084185OtherNPI2