Healthcare Provider Details

I. General information

NPI: 1639083207
Provider Name (Legal Business Name): ATNITA CRUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 VALENCIA DR
PONTIAC MI
48342-1678
US

IV. Provider business mailing address

524 VALENCIA DR
PONTIAC MI
48342-1678
US

V. Phone/Fax

Practice location:
  • Phone: 947-800-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberMI04092025991323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: