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Individual
NINA ELISABETH GRAM HUMPHREY
Active
Individual
NINA ELISABETH GRAM HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA052452
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1069736
NCCPA CERT NO.
—
Enumeration date
03/09/2006
Last updated
01/13/2016
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