Provider Demographics
NPI:1629797089
Name:CRUMRINE, CLAUDIA GRACE
Entity Type:Individual
Prefix:MISS
First Name:CLAUDIA
Middle Name:GRACE
Last Name:CRUMRINE
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 1:555 W COURT ST STE 214
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3674
Mailing Address - Country:US
Mailing Address - Phone:815-928-6131
Mailing Address - Fax:
Practice Address - Street 1:555 W COURT ST STE 214
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3674
Practice Address - Country:US
Practice Address - Phone:815-928-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009288363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical