Provider Demographics
NPI:1023079357
Name:MCCRISKIN, NANCY (ATC/L)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MCCRISKIN
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25085 EAGLE PT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748-7505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 EAST EMERSON
Practice Address - Street 2:ILLINOIS WESLEYAN UNIVERSITY TRAINING ROOM
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61702
Practice Address - Country:US
Practice Address - Phone:309-556-3601
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer