Provider Demographics
NPI:1023042660
Name:CRUMRINE, JOAN (CNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CRUMRINE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LICKING MEMORIAL FAMILY PRACTICE EAST
Mailing Address - Street 2:399 E. MAIN ST
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-1846
Mailing Address - Fax:220-564-1847
Practice Address - Street 1:LICKING MEMORIAL FAMILY PRACTICE EAST
Practice Address - Street 2:399 E. MAIN ST
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-1846
Practice Address - Fax:220-564-1847
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-00227-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144521Medicaid
OHH083312Medicare PIN