Healthcare Provider Details

I. General information

NPI: 1629890181
Provider Name (Legal Business Name): ANNEMARIE JUDITH HUMPHRESS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNEMARIE JUDITH CANNING

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E WALNUT ST STE A
EVANSVILLE IN
47713-2460
US

IV. Provider business mailing address

610 E WALNUT ST STE A
EVANSVILLE IN
47713-2460
US

V. Phone/Fax

Practice location:
  • Phone: 844-999-9019
  • Fax:
Mailing address:
  • Phone: 844-999-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015953A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: