Healthcare Provider Details

I. General information

NPI: 1821851163
Provider Name (Legal Business Name): CHARRON ARIEL HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 MONTGOMERY RD STE 23B
MONTGOMERY OH
45242-7794
US

IV. Provider business mailing address

9200 MONTGOMERY RD STE 23B
MONTGOMERY OH
45242-7794
US

V. Phone/Fax

Practice location:
  • Phone: 513-807-2563
  • Fax:
Mailing address:
  • Phone: 513-807-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN.489963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: