Healthcare Provider Details

I. General information

NPI: 1730833476
Provider Name (Legal Business Name): LYNNETTE CRUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 W THURSTON AVE
MILWAUKEE WI
53218-2264
US

IV. Provider business mailing address

PO BOX 250631
MILWAUKEE WI
53225-6508
US

V. Phone/Fax

Practice location:
  • Phone: 414-852-7150
  • Fax:
Mailing address:
  • Phone: 414-852-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: