Provider Demographics
NPI:1356671317
Name:CRIPPS, DESIREE LISETTE (CPM)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:LISETTE
Last Name:CRIPPS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 DELICIOUS RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642-6135
Mailing Address - Country:US
Mailing Address - Phone:703-930-3581
Mailing Address - Fax:
Practice Address - Street 1:205 E COURT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1728
Practice Address - Country:US
Practice Address - Phone:703-930-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife