Provider Demographics
NPI:1871181842
Name:CRUM, CELESTE C
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:C
Last Name:CRUM
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 1:122 ORCHARD DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1121
Mailing Address - Country:US
Mailing Address - Phone:301-992-7541
Mailing Address - Fax:
Practice Address - Street 1:122 ORCHARD DR UNIT A
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1121
Practice Address - Country:US
Practice Address - Phone:301-992-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide