Provider Demographics
NPI:1366233314
Name:MURDOCK, POLLY ROSE (LM, CPM)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:ROSE
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7227
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-7227
Mailing Address - Country:US
Mailing Address - Phone:406-209-1394
Mailing Address - Fax:406-219-5991
Practice Address - Street 1:7600 SHEDHORN DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9462
Practice Address - Country:US
Practice Address - Phone:406-209-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-MID-LIC-131192176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife