Provider Demographics
NPI:1235532920
Name:CRUMB, AMY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MICHELLE
Last Name:CRUMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37413 SUMAC AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6027
Mailing Address - Country:US
Mailing Address - Phone:661-718-7906
Mailing Address - Fax:
Practice Address - Street 1:506 W JACKMAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2531
Practice Address - Country:US
Practice Address - Phone:661-726-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program