Provider Demographics
NPI:1629808829
Name:MURRAY, VADA BROOKE (PA)
Entity type:Individual
Prefix:
First Name:VADA
Middle Name:BROOKE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15316 TIMBER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6185
Mailing Address - Country:US
Mailing Address - Phone:224-688-9597
Mailing Address - Fax:
Practice Address - Street 1:507 N 17TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2104
Practice Address - Country:US
Practice Address - Phone:224-688-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant