Provider Demographics
NPI:1336549260
Name:CRISP, JOHN JOSHUA (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSHUA
Last Name:CRISP
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 E POWERS PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5145
Mailing Address - Country:US
Mailing Address - Phone:720-261-1358
Mailing Address - Fax:
Practice Address - Street 1:19001 E POWERS PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5145
Practice Address - Country:US
Practice Address - Phone:720-261-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0204326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse