Basic Information
Provider Information
NPI: 1104569359
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MURRAY
FirstName: RENEE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 GRANADA PARK
Address2:  
City: BOSTON
State: MA
PostalCode: 021193136
CountryCode: US
TelephoneNumber: 6179629636
FaxNumber:  
Practice Location
Address1: MALLENNIUM TRAVEL NURSING
Address2: 25 BRAINTREE HILL OFFICE PK
City: BRAINTREE
State: MA
PostalCode: 02184
CountryCode: US
TelephoneNumber: 7819715019
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/15/2022
LastUpdateDate: 04/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN2343147MAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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