Healthcare Provider Details

I. General information

NPI: 1104279215
Provider Name (Legal Business Name): ASHLEY ELIZABETH CRUMB NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S GEDDES ST
SYRACUSE NY
13204-3837
US

IV. Provider business mailing address

930 S SALINA ST
SYRACUSE NY
13202-3530
US

V. Phone/Fax

Practice location:
  • Phone: 315-572-1663
  • Fax:
Mailing address:
  • Phone: 315-453-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number683370
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344477-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: