Provider Demographics
NPI:1851846299
Name:HUMPHREY, BRITTNEY (BS; LMT)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:BS; LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 E ROCK RD
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9433
Mailing Address - Country:US
Mailing Address - Phone:989-802-1849
Mailing Address - Fax:
Practice Address - Street 1:1511 E ROCK RD
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9433
Practice Address - Country:US
Practice Address - Phone:989-802-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009658172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker