Provider Demographics
NPI:1285014225
Name:CRIPPIN, NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CRIPPIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6279
Mailing Address - Country:US
Mailing Address - Phone:563-421-5700
Mailing Address - Fax:563-421-5839
Practice Address - Street 1:2140 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6279
Practice Address - Country:US
Practice Address - Phone:563-421-5700
Practice Address - Fax:563-421-5839
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08602207Q00000X
IADO-05162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine