Provider Demographics
NPI:1124996111
Name:HUMPHRIES, DORENE ANN
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:ANN
Last Name:HUMPHRIES
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 1:6700 MELRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2154
Mailing Address - Country:US
Mailing Address - Phone:440-840-3725
Mailing Address - Fax:440-853-7441
Practice Address - Street 1:6700 MELRIDGE DR
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-2154
Practice Address - Country:US
Practice Address - Phone:440-840-3725
Practice Address - Fax:440-853-7441
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty