Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 6246-33 | WI |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 6246-33 | WI |
NPI | 1104224575 |
---|---|
Provider Name | Amber K. Humphries |
First Address | Sheboygan, WI 53083-4932 |
Second Address | Sheboygan, WI 53083-4932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104224575 | (05) | WI |