Provider Demographics
NPI:1699077412
Name:HUMPHRIES, ELIZABETH (RN,CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:RN,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1823
Mailing Address - Country:US
Mailing Address - Phone:608-770-2730
Mailing Address - Fax:
Practice Address - Street 1:2911 MARINA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1823
Practice Address - Country:US
Practice Address - Phone:608-770-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137774-030163WG0000X
WI137774-032163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice