Healthcare Provider Details

I. General information

NPI: 1932978244
Provider Name (Legal Business Name): KIMBERLY MARIE CRUSER BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM CRUSER BSN, IBCLC

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 BALTIMORE PIKE
OXFORD PA
19363-3926
US

IV. Provider business mailing address

2553 BALTIMORE PIKE
OXFORD PA
19363-3926
US

V. Phone/Fax

Practice location:
  • Phone: 610-563-7285
  • Fax:
Mailing address:
  • Phone: 610-563-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-134904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: