Individual
NICOLE MARIE HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5510 N 130TH AVE, LITCHFIELD PARK, AZ 85340-3009
(618) 920-6548
Mailing address
5510 N 130TH AVE, LITCHFIELD PARK, AZ 85340-3009
(618) 920-6548
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2017038321
MO
363LG0600X
Gerontology Nurse Practitioner
2017038321
MO
363LG0600X
Gerontology Nurse Practitioner
209017369
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
292500
AZ
Other
Enumeration date
11/03/2017
Last updated
08/15/2023
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