Healthcare Provider Details

I. General information

NPI: 1093569733
Provider Name (Legal Business Name): NORMA ELAINE CRESPO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. NORMA ELAINE MIGHTY

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 MARTIN LUTHER KING JR DR SW
ATLANTA GA
30311-1715
US

IV. Provider business mailing address

1534 CRESCENT LN APT K
MATTHEWS NC
28105-4695
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-7774
  • Fax:
Mailing address:
  • Phone: 919-696-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number363343
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: