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General NPI Number Information
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NPI Number | 1104279215
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Entity Type | Individual
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Provider Name | ASHLEY ELIZABETH CRUMB NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 900 S GEDDES ST
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City | SYRACUSE
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State | NY
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Zip | 13204-3837
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Country | US
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Telephone | 315-572-1663
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Fax |
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Provider Business Mailing Address
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Address Line | 930 S SALINA ST
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City | SYRACUSE
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State | NY
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Zip | 13202-3530
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Country | US
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Telephone | 315-453-4453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 683370
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F344477-1
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License Number State | NY
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