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General NPI Number Information
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NPI Number | 1154728590
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Entity Type | Organization
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Legal Business Name | LAVERN WASHINGTON HUMPHRIES
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 8521 SAGE MEADOW DR
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City | TEMPLE
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State | TX
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Zip | 76502-5041
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Country | US
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Telephone | 254-931-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 8521 SAGE MEADOW DR
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City | TEMPLE
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State | TX
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Zip | 76502-5041
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Country | US
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Telephone | 254-931-7140
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | LAVERN WASHINGTON HUMPHRIES
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Credential | NURSING LICENSE
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Telephone | 254-931-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 836362
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License Number State | TX
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