Healthcare Provider Details

I. General information

NPI: 1295009744
Provider Name (Legal Business Name): KATHLEEN J. HUMPHREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W BUFFALO ST
WARSAW NY
14569-1242
US

IV. Provider business mailing address

153 W BUFFALO ST
WARSAW NY
14569-1242
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8000
  • Fax: 585-786-8352
Mailing address:
  • Phone: 585-786-8000
  • Fax: 585-786-8352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number293161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: