Individual
JANETTE HUMPOLICK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
509 LAKE RD, DYERSBURG, TN 38024-3877
(731) 287-0804
(731) 287-7373
Mailing address
509 LAKE RD, DYERSBURG, TN 38024-3877
(731) 287-0804
(731) 287-7373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00000000404
TN
Other
Enumeration date
02/24/2006
Last updated
07/08/2007
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