Provider Demographics
NPI:1821851163
Name:HUMPHREY, CHARRON ARIEL
Entity Type:Individual
Prefix:
First Name:CHARRON
Middle Name:ARIEL
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MONTGOMERY RD STE 23B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7794
Mailing Address - Country:US
Mailing Address - Phone:513-807-2563
Mailing Address - Fax:
Practice Address - Street 1:9200 MONTGOMERY RD STE 23B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7794
Practice Address - Country:US
Practice Address - Phone:513-807-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.489963163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology