Healthcare Provider Details

I. General information

NPI: 1366821712
Provider Name (Legal Business Name): MICHELLE CRASS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COVERED BRIDGE RD
CHERRY HILL NJ
08034-2945
US

IV. Provider business mailing address

27 COVERED BRIDGE RD
CHERRY HILL NJ
08034-2945
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax:
Mailing address:
  • Phone: 856-429-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ005653000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: