Provider Demographics
NPI:1659506434
Name:HUMPHREYS, BRANDI LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LYNN
Last Name:HUMPHREYS
Suffix:
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 1:213 GREYSTONE LN
Mailing Address - Street 2:APT 25
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5114
Mailing Address - Country:US
Mailing Address - Phone:585-233-9631
Mailing Address - Fax:
Practice Address - Street 1:213 GREYSTONE LN
Practice Address - Street 2:APT 25
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5114
Practice Address - Country:US
Practice Address - Phone:585-233-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290987-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse