Individual
TIA HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9207 SENECA TRL, RONCEVERTE, WV 24970-1328
(304) 645-1787
(304) 645-3630
Mailing address
9207 SENECA TRL, RONCEVERTE, WV 24970-1328
(304) 645-1787
(304) 645-3630
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
24712
WV
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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