Healthcare Provider Details

I. General information

NPI: 1730892076
Provider Name (Legal Business Name): SARA JANE HUMBERT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

290 BUENA VISTA PL
MEMPHIS TN
38112-5404
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-3500
  • Fax: 901-545-3509
Mailing address:
  • Phone: 901-355-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number33267
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: