MEDICARE: OSHA HUMPHREY CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1659105567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSHA HUMPHREY CNM

Provider Business Mailing Address
First Line	:	2732 FOREST LAKE DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5508
Country	:	US
Telephone Number	:	517-250-7986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 FOREST LAKE DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-5508
Country	:	US
Telephone Number	:	517-250-7986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	07/06/2025

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