Provider Demographics
NPI:1659105567
Name:HUMPHREY, OSHA (CNM)
Entity type:Individual
Prefix:
First Name:OSHA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5508
Mailing Address - Country:US
Mailing Address - Phone:517-250-7986
Mailing Address - Fax:
Practice Address - Street 1:2732 FOREST LAKE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5508
Practice Address - Country:US
Practice Address - Phone:517-250-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife