Provider Demographics
NPI:1679976930
Name:MURPHY, LAURA LEA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1134
Mailing Address - Country:US
Mailing Address - Phone:309-453-6993
Mailing Address - Fax:
Practice Address - Street 1:1200 W LOUCKS AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-2604
Practice Address - Country:US
Practice Address - Phone:309-688-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner