Provider Demographics
NPI:1447056288
Name:HUMPHREY, MYRANDA MAE
Entity type:Individual
Prefix:
First Name:MYRANDA
Middle Name:MAE
Last Name:HUMPHREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3650
Mailing Address - Country:US
Mailing Address - Phone:402-239-9011
Mailing Address - Fax:
Practice Address - Street 1:1934 N 31ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1301
Practice Address - Country:US
Practice Address - Phone:402-239-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant