Provider Demographics
NPI:1760435523
Name:HUMPHREY, CYNTHIA B (FNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:B
Last Name:HUMPHREY
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 1:530 NEW WAVERLY PL
Mailing Address - Street 2:STE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7414
Mailing Address - Country:US
Mailing Address - Phone:919-233-3959
Mailing Address - Fax:919-233-1003
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:STE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-233-3959
Practice Address - Fax:919-233-1003
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC098296363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR40663Medicare UPIN
NC2592646Medicare PIN
NC2329415Medicare PIN