Individual
MRS. JEANNINE DANIELLE HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NT
Contact information
Practice address
216 WESTPORT DR, JOLIET, IL 60431-4939
(815) 791-9157
(815) 207-7828
Mailing address
216 WESTPORT DR, JOLIET, IL 60431-4939
(815) 791-9157
(815) 207-7828
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
164003156
IL
Other
Enumeration date
03/05/2007
Last updated
08/25/2008
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