Individual
DR. VANESSA R HUMPHREVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
909 FULTON ST SE, MINNEAPOLIS, MN 55455-4800
(612) 672-7422
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
53909
MN
208600000X
Surgery Physician
53909
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0088029
—
OH
01
—
35.121580
LICENSE
OH
Enumeration date
05/22/2007
Last updated
07/31/2020
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