Provider Demographics
NPI:1679855381
Name:CRIM, MELISSA ANN (STNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:CRIM
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 MIDDLE AVE
Mailing Address - Street 2:1
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7666
Mailing Address - Country:US
Mailing Address - Phone:440-452-8992
Mailing Address - Fax:
Practice Address - Street 1:1604 MIDDLE AVE
Practice Address - Street 2:1
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7666
Practice Address - Country:US
Practice Address - Phone:440-452-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401050080310376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide