Individual
MRS. JACQUELINE MARIE HUMPHERYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
5183 SADDLE STRAP WAY, PINETOP, AZ 85935-7535
(928) 369-1111
Mailing address
5183 SADDLE STRAP WAY, PINETOP, AZ 85935-7535
(928) 369-1111
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
807654
ID
Other
Enumeration date
09/25/2008
Last updated
09/25/2008
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