Provider Demographics
NPI:1922387307
Name:HUMPHREY, DAVEIN RENEE (RN, MSN, APN-BC)
Entity Type:Individual
Prefix:
First Name:DAVEIN
Middle Name:RENEE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:RN, MSN, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3419
Mailing Address - Country:US
Mailing Address - Phone:209-826-0591
Mailing Address - Fax:
Practice Address - Street 1:520 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3419
Practice Address - Country:US
Practice Address - Phone:209-826-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily