Individual
STEPHANIE HUMBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
367 E MAIN ST, WATERLOO, NY 13165-1662
(315) 521-9228
Mailing address
3605 LAKES CORNERS ROSE VALLEY RD, CLYDE, NY 14433-9606
(315) 521-9228
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
F351974-01
NY
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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