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NPI Code Detail

MEDICARE: MS. SUSAN HUMPHRIES RN

MEDICARE: MS. SUSAN HUMPHRIES RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN080476LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790812170
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN HUMPHRIES RN
Provider Business Mailing Address
First Line : 3014 N 12TH ST
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-5021
Country : US
Telephone Number : 318-267-0840
Fax Number :
Provider Business Practice Location Address
First Line : 901 N 4TH ST
Second Line :
City : MONROE
State : LA
Zip : 71201-5909
Country : US
Telephone Number : 318-387-7817
Fax Number : 318-322-0914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 07/09/2007

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