Provider Demographics
NPI:1548971575
Name:HUMPHREY, MICHAELA C (APRN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:C
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 425
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2340
Mailing Address - Country:US
Mailing Address - Phone:216-643-2780
Mailing Address - Fax:216-524-0111
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 425
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2340
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0032706363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily