Healthcare Provider Details

I. General information

NPI: 1508158072
Provider Name (Legal Business Name): ANN GERMAINE CRENSHAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S LUDLOW ST
DAYTON OH
45402-2610
US

IV. Provider business mailing address

725 S LUDLOW ST
DAYTON OH
45402-2610
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8816
  • Fax: 937-208-8828
Mailing address:
  • Phone: 937-208-8816
  • Fax: 937-208-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN.204256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: