Provider Demographics
NPI:1548995871
Name:HUMPHREY, CHRISTINE M (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1268 142ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-6644
Mailing Address - Country:US
Mailing Address - Phone:715-220-9533
Mailing Address - Fax:
Practice Address - Street 1:3555 WILLOW LAKE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-4465
Practice Address - Country:US
Practice Address - Phone:952-431-5330
Practice Address - Fax:952-431-5334
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2480748163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health