Provider Demographics
NPI:1922003367
Name:CRUMMEL, NANCY ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:CRUMMEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 ARLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7933
Mailing Address - Country:US
Mailing Address - Phone:231-932-1942
Mailing Address - Fax:
Practice Address - Street 1:1211 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2317
Practice Address - Country:US
Practice Address - Phone:231-935-4886
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3414075Medicaid
MIS18439Medicare UPIN
MIOM23810Medicare ID - Type Unspecified