Provider Demographics
NPI:1053120964
Name:MURPHY, MARISA ANN
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 15TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1999
Mailing Address - Country:US
Mailing Address - Phone:320-309-3729
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:DEPARTMENT OF DENTISTRY & OMS, SUITE 2C-319
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program