Provider Demographics
NPI:1205507589
Name:CRISP, AUTUMN ELIZABETH (CNP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ELIZABETH
Last Name:CRISP
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29054 SW MEEK LOOP APT 248
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6512
Mailing Address - Country:US
Mailing Address - Phone:216-466-2424
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE B1
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1474
Practice Address - Country:US
Practice Address - Phone:330-375-4844
Practice Address - Fax:330-375-4067
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020313363LW0102X
OH0029806363LX0001X
OHAPRN.CNP.0029806207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty