Healthcare Provider Details

I. General information

NPI: 1588772651
Provider Name (Legal Business Name): LOU ANN CRUME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 12TH ST
BUTNER NC
27509-1626
US

IV. Provider business mailing address

1003 12TH STREET
BUTNER NC
27509-1626
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-7233
  • Fax: 919-575-7643
Mailing address:
  • Phone: 919-575-7233
  • Fax: 919-575-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31970
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: