Provider Demographics
NPI:1912528308
Name:HUMPHREY, ROSHAWNDA ROCHELLE
Entity Type:Individual
Prefix:
First Name:ROSHAWNDA
Middle Name:ROCHELLE
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 1:4327 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1268
Mailing Address - Country:US
Mailing Address - Phone:330-774-6558
Mailing Address - Fax:
Practice Address - Street 1:4327 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-1268
Practice Address - Country:US
Practice Address - Phone:330-774-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker