Healthcare Provider Details

I. General information

NPI: 1659105567
Provider Name (Legal Business Name): OSHA HUMPHREY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 FOREST LAKE DR
JACKSON MI
49203-5508
US

IV. Provider business mailing address

2732 FOREST LAKE DR
JACKSON MI
49203-5508
US

V. Phone/Fax

Practice location:
  • Phone: 517-250-7986
  • Fax:
Mailing address:
  • Phone: 517-250-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: