Provider Demographics
NPI:1396287553
Name:HUMPHREY, JOAN M (CRNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:RICCIARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-981-2246
Mailing Address - Fax:724-981-0553
Practice Address - Street 1:63 PITT ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2102
Practice Address - Country:US
Practice Address - Phone:724-342-6604
Practice Address - Fax:724-342-1601
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032320300005Medicaid