Healthcare Provider Details

I. General information

NPI: 1437214608
Provider Name (Legal Business Name): STEPHEN ROBERT CRUMB NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PLEASANTVILLE RD STE 202
LANCASTER OH
43130-3346
US

IV. Provider business mailing address

401 N EWING ST
LANCASTER OH
43130-3372
US

V. Phone/Fax

Practice location:
  • Phone: 740-681-9020
  • Fax: 740-681-9112
Mailing address:
  • Phone: 740-681-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number08796
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA08796 NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.08796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: