Provider Demographics
NPI:1558003590
Name:HUMPHREY, ASHLEY LYNN I (LPN)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:LYNN
Last Name:HUMPHREY
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 STONE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9553
Mailing Address - Country:US
Mailing Address - Phone:315-651-3286
Mailing Address - Fax:
Practice Address - Street 1:20 BAY VIEW TER
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-9768
Practice Address - Country:US
Practice Address - Phone:315-945-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337958164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse