Active NPI
Stephanie Humphries
- Licensed Practical Nurse
- Pontiac, MI
National Provider Identifier
1942690995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 000000000
- Practice address
- 321 Arnold Ave
Pontiac, MI 48341-1061 - Phone
- (248) 255-5630
- NPI assigned
- Jan 29, 2015
- Last updated
- Jan 29, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 000000000 | MI | Primary |
Addresses
Primary practice location
321 Arnold Ave
Pontiac, MI 48341-1061
Mailing address
321 Arnold Ave
Pontiac, MI 48341-1061
Phone (248) 255-5630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 230008922620703 | Other | MI | CNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000000 | MI | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422489600000",
"number": "1942690995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 ARNOLD AVE",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411061",
"telephone_number": "248-255-5630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 ARNOLD AVE",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411061",
"telephone_number": "248-255-5630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHRIES",
"first_name": "STEPHANIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-29",
"last_updated": "2015-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MI",
"license": "000000000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CNA",
"identifier": "230008922620703",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.