Provider Demographics
NPI:1518341098
Name:CRESCENZO, MAURA ANN (NP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:ANN
Last Name:CRESCENZO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 W BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-8601
Mailing Address - Country:US
Mailing Address - Phone:517-486-2411
Mailing Address - Fax:517-486-3967
Practice Address - Street 1:157 W BROOKE LN
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228
Practice Address - Country:US
Practice Address - Phone:517-486-2411
Practice Address - Fax:517-486-3967
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17682-NP363LF0000X
MI4704347832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518341098Medicaid
OH0139529Medicaid
MIM35150171OtherMI MEDICARE