Basic Information
| Provider Information | |||||||||
| NPI: | 1376991638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMBLE | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 PENNS WAY | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197202407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026522455 | ||||||||
| FaxNumber: | 3023226251 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W BALTIMORE PIKE STE 200 | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193909313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108694627 | ||||||||
| FaxNumber: | 6108698407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2016 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | LG0000939 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.