Provider Demographics
NPI:1821878695
Name:HUMPHREY, SABRINA RENEE
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:RENEE
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 1:125 N RIVER RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-1931
Mailing Address - Country:US
Mailing Address - Phone:989-484-8336
Mailing Address - Fax:
Practice Address - Street 1:125 N RIVER RD APT 102
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1931
Practice Address - Country:US
Practice Address - Phone:989-484-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802909130171W00000X, 343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171W00000XOther Service ProvidersContractor