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General NPI Number Information
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NPI Number | 1790944395
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Entity Type | Individual
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Provider Name | ERIN B HUMPHREY DO
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 5300 MEMORIAL DR
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City | TWO RIVERS
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State | WI
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Zip | 54241-3923
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Country | US
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Telephone | 920-793-7420
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Fax | 217-224-9383
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Provider Business Mailing Address
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Address Line | 5300 MEMORIAL DR
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City | TWO RIVERS
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State | WI
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Zip | 54241-3923
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Country | US
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Telephone | 920-793-7420
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Fax | 217-224-9383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-129525
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 70217
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License Number State | WI
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