Doctor Name: | KATHRYN L HUMPHREY |
NPI Number: | 1639342777 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 3264 N Evergreen Dr Ne Grand Rapids, MI - 495259746 |
Business Phone Number: | 6163637339 |
Business Fax Number: | 6163615828 |
Mailing Address: | 3264 N Evergreen Dr Ne, GRAND RAPIDS |
State: | MI |
Postal Code: | 495259746 |
Phone Number: | 6163637339 |
Fax Number: | 6163615828 |
NPI Enumeration Date: | 04/09/2008 |
NPI Last Update Date: | 04/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |