Provider Demographics
NPI:1649923673
Name:CRIMM, ABIGAIL AMANDA (LAC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:AMANDA
Last Name:CRIMM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MILL ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4771
Mailing Address - Country:US
Mailing Address - Phone:530-648-4192
Mailing Address - Fax:
Practice Address - Street 1:152 MILL ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4771
Practice Address - Country:US
Practice Address - Phone:530-648-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist