Provider Demographics
NPI:1043475171
Name:CRISP, ANDREA (BSN RN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:64 JOHN CROWE RD
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:
Practice Address - Street 1:64 JOHN CROWE RD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68211163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8600501Medicaid
NC68211OtherRN