Provider Demographics
NPI:1891251153
Name:CRESPIN, MELISSA RAE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:CRESPIN
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 1:1721 KINGSROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2173
Mailing Address - Country:US
Mailing Address - Phone:719-415-8349
Mailing Address - Fax:
Practice Address - Street 1:1721 KINGSROYAL BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2173
Practice Address - Country:US
Practice Address - Phone:719-415-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0129495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse