Provider Demographics
NPI:1558099838
Name:CRUMLEY, CASSANDRA LEE (PA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:CRUMLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 AOLOA PL APT 228
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5207
Mailing Address - Country:US
Mailing Address - Phone:720-431-2157
Mailing Address - Fax:
Practice Address - Street 1:1015 AOLOA PL APT 228
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5207
Practice Address - Country:US
Practice Address - Phone:720-431-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program