Basic Information
| Provider Information | |||||||||
| NPI: | 1649997594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | SKYE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 MURCH RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040057412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075902213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8270 WILLOW OAKS CORPORATE DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2022 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.