Provider Demographics
NPI:1912763459
Name:CRUPE, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CRUPE
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 1:17 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26060-8087
Mailing Address - Country:US
Mailing Address - Phone:304-231-8648
Mailing Address - Fax:
Practice Address - Street 1:17 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY GROVE
Practice Address - State:WV
Practice Address - Zip Code:26060-8087
Practice Address - Country:US
Practice Address - Phone:304-231-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker