Provider Demographics
NPI:1518727882
Name:HUMPHREY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LOUISE
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:GRAPEVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98546-0527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4490 EAST GRAPEVIEW LOOP ROAD
Practice Address - Street 2:
Practice Address - City:GRAPEVIEW
Practice Address - State:WA
Practice Address - Zip Code:98546
Practice Address - Country:US
Practice Address - Phone:360-801-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider