Individual
DALISSE HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
2760 AIRPORT DR, COLUMBUS, OH 43219-2284
(937) 286-7490
Mailing address
PO BOX 340093, DAYTON, OH 45434-0093
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN. 313216
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2595802
—
OH
Enumeration date
02/28/2007
Last updated
11/02/2010
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