1114168440 NPI number — LAURA CRUM CRNP

Table of content: LAURA CRUM CRNP (NPI 1114168440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114168440 NPI number — LAURA CRUM CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUM
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114168440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20280 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONANCOCK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23417-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-140-4007
Provider Business Mailing Address Fax Number:
574-140-5697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20306 BADGE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONLEY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-787-7374
Provider Business Practice Location Address Fax Number:
757-787-4513
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  R083401 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 188461100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890001900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040601500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155191400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 267791100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 543306100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com