Provider Demographics
NPI:1780261339
Name:CRULL, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:CRULL
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 1:6711 S CHICKAHAUK TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5126
Mailing Address - Country:US
Mailing Address - Phone:815-494-0474
Mailing Address - Fax:
Practice Address - Street 1:6711 S CHICKAHAUK TRL
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5126
Practice Address - Country:US
Practice Address - Phone:815-494-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11411-33367500000X
IL209023563367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered