Provider Demographics
NPI:1881072197
Name:CRUMP, JOANIE
Entity type:Individual
Prefix:
First Name:JOANIE
Middle Name:
Last Name:CRUMP
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 1:4402 28TH PL
Mailing Address - Street 2:APT. 4
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1539
Mailing Address - Country:US
Mailing Address - Phone:301-779-4033
Mailing Address - Fax:
Practice Address - Street 1:4402 28TH PL
Practice Address - Street 2:APT. 4
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1539
Practice Address - Country:US
Practice Address - Phone:301-779-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1007802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse