Provider Demographics
NPI:1568043073
Name:CRISPIN, SUSANA (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:CRISPIN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 MILITARY CUTOFF RD STE CC-351
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7215 OGDEN BUSINESS LN STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7376
Practice Address - Country:US
Practice Address - Phone:910-408-2052
Practice Address - Fax:910-249-4333
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach