Provider Demographics
NPI:1871511980
Name:CRIM, MONICA GAIL (APN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:GAIL
Last Name:CRIM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 E MAIN ST
Mailing Address - Street 2:P O BOX 468
Mailing Address - City:LA HARPE
Mailing Address - State:IL
Mailing Address - Zip Code:61450-9461
Mailing Address - Country:US
Mailing Address - Phone:217-659-3844
Mailing Address - Fax:217-659-3850
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:BOX 468
Practice Address - City:LA HARPE
Practice Address - State:IL
Practice Address - Zip Code:61450-9461
Practice Address - Country:US
Practice Address - Phone:217-659-3844
Practice Address - Fax:217-659-3850
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000465363LF0000X
IL277000345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15838Medicare UPIN