Provider Demographics
NPI:1982317319
Name:CRUMPLER, AMANDA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:CRUMPLER
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 1:2869 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:PETERSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:24963-5037
Mailing Address - Country:US
Mailing Address - Phone:304-753-4336
Mailing Address - Fax:304-753-4097
Practice Address - Street 1:2869 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963-5037
Practice Address - Country:US
Practice Address - Phone:304-753-4336
Practice Address - Fax:304-753-4097
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002092777164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse