Individual
CHRIS M HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
410 EAGLE CT, WHITEWATER, WI 53190-1575
(262) 473-3295
Mailing address
410 EAGLE CT, WHITEWATER, WI 53190-1575
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
29820-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39871900
—
WI
Enumeration date
09/20/2007
Last updated
09/20/2007
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