Provider Demographics
NPI:1063759553
Name:HUMPHREY, KARMA JENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:KARMA
Middle Name:JENEE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 FORRER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3511
Mailing Address - Country:US
Mailing Address - Phone:419-283-3029
Mailing Address - Fax:
Practice Address - Street 1:2266 FORRER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3511
Practice Address - Country:US
Practice Address - Phone:419-283-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN139828MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse