Provider Demographics
NPI:1053699744
Name:MURTO, NANCY (COTA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MURTO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6062 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48428-9336
Mailing Address - Country:US
Mailing Address - Phone:810-796-3049
Mailing Address - Fax:
Practice Address - Street 1:6062 KINGS CT
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:MI
Practice Address - Zip Code:48428-9336
Practice Address - Country:US
Practice Address - Phone:810-796-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI52020068122083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine