Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 53909 | MN |
N | 208200000X | Surgeon | 53909 | MN |
N | 208600000X | Surgeon | 53909 | MN |
NPI | 1255540498 |
---|---|
Provider Name | Dr. Vanessa R Humphreville |
First Address | Euclid, OH 44117-1714 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0088029 | (05) | OH |
35.121580 | LICENSE (01) | OH |