Provider Demographics
NPI:1588012306
Name:CRISPIN, MICHELLE JUNE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JUNE
Last Name:CRISPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#7 SHIPTON LANE
Mailing Address - Street 2:
Mailing Address - City:FT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514
Mailing Address - Country:US
Mailing Address - Phone:307-335-1169
Mailing Address - Fax:307-335-1170
Practice Address - Street 1:#7 SHIPTON LANE
Practice Address - Street 2:
Practice Address - City:FT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-335-1169
Practice Address - Fax:307-335-1170
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist