Provider Demographics
NPI:1407093966
Name:HUMBACH, EVA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:HUMBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1210
Mailing Address - Country:US
Mailing Address - Phone:845-848-7917
Mailing Address - Fax:845-359-7227
Practice Address - Street 1:470 WESTERN HWY
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1210
Practice Address - Country:US
Practice Address - Phone:845-848-7917
Practice Address - Fax:845-359-7227
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily