Provider Demographics
NPI:1942061387
Name:HUMPHREY, BRITTANY DANIELLE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DANIELLE
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 1:3703 N DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-1610
Mailing Address - Country:US
Mailing Address - Phone:317-476-1024
Mailing Address - Fax:507-585-1784
Practice Address - Street 1:3703 N DREXEL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-1610
Practice Address - Country:US
Practice Address - Phone:317-476-1024
Practice Address - Fax:507-585-1784
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide