Provider Demographics
NPI:1598519852
Name:CRUMBLEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CRUMBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAE
Other - Middle Name:
Other - Last Name:CRUMBLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DRIVE
Mailing Address - Street 2:TAUBMAN CENTER, 2 ND FLOOR, RECEPTION C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:TAUBMAN CENTER, 2 ND FLOOR, RECEPTION C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-936-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052130390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program