Provider Demographics
NPI:1245937564
Name:CRISENO, ERWIN LUMAGUI (NP-C)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:LUMAGUI
Last Name:CRISENO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9014
Mailing Address - Country:US
Mailing Address - Phone:916-865-6841
Mailing Address - Fax:
Practice Address - Street 1:3249 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9014
Practice Address - Country:US
Practice Address - Phone:916-865-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95019460OtherCA BOARD OF REGISTERED NURSING, NURSE PRACTITIONER FURNISHING