Provider Demographics
NPI:1811540941
Name:MOORE-CRUM, ALLISON RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:MOORE-CRUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8174 N PLANTATION PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4038
Mailing Address - Country:US
Mailing Address - Phone:520-572-6205
Mailing Address - Fax:520-744-8963
Practice Address - Street 1:8174 N PLANTATION PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4038
Practice Address - Country:US
Practice Address - Phone:520-572-6205
Practice Address - Fax:520-744-8963
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP049059164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse