1194043331 NPI number — ERIN MCCAFFREY CRESPO FNP-BC, CRNP

Table of content: ERIN MCCAFFREY CRESPO FNP-BC, CRNP (NPI 1194043331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194043331 NPI number — ERIN MCCAFFREY CRESPO FNP-BC, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCAFFREY CRESPO
Provider First Name:
ERIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCAFFREY
Provider Other First Name:
ERIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194043331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 W JOHNSTOWN RD STE 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-2888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-697-3339
Provider Business Mailing Address Fax Number:
866-264-2760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 W JOHNSTOWN RD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-2888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-697-3339
Provider Business Practice Location Address Fax Number:
866-264-2760
Provider Enumeration Date:
05/12/2010

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: 363LF0000X , with the licence number:  RN1013959 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R183476 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024168739 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP012721 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN.CNP.17266 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102889352 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".