Provider Demographics
NPI:1427596154
Name:CRISPELL, STEPHANIE MARIAN (ATC, EMT-B)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIAN
Last Name:CRISPELL
Suffix:
Gender:F
Credentials:ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 W RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4348
Mailing Address - Country:US
Mailing Address - Phone:800-974-5774
Mailing Address - Fax:
Practice Address - Street 1:510 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9597
Practice Address - Country:US
Practice Address - Phone:717-919-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA216361146N00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA216361OtherPA DEPARTMENT OF HEALTH - EMT-B