Provider Demographics
NPI: | 1457808792 |
---|---|
Name: | CRISP, JOAN |
Entity Type: | Individual |
Prefix: | |
First Name: | JOAN |
Middle Name: | |
Last Name: | CRISP |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2160 MARTIN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LIMESTONE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37681-4756 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-775-1475 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2160 MARTIN RD |
Practice Address - Street 2: | |
Practice Address - City: | LIMESTONE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37681-4756 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-775-1475 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-09-03 |
Last Update Date: | 2016-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 196154 | 246QC1000X, 246QH0000X, 246QI0000X, 246QM0900X |
196154 | 246QB0000X, 246RM2200X, 246RP1900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 246QC1000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Chemistry |
No | 246QB0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Blood Banking |
No | 246QH0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Hematology |
No | 246QI0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Immunology |
No | 246QM0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Microbiology |
No | 246RM2200X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Medical Laboratory |
No | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy |