Provider Demographics
NPI:1437214608
Name:CRUMB, STEPHEN ROBERT (NP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:CRUMB
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3372
Mailing Address - Country:US
Mailing Address - Phone:740-681-9020
Mailing Address - Fax:
Practice Address - Street 1:618 PLEASANTVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3346
Practice Address - Country:US
Practice Address - Phone:740-681-9020
Practice Address - Fax:740-681-9112
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA08796 NP363LA2200X
OHAPRN.CNP.08796363LP0200X
OH08796363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3028708Medicaid