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General NPI Number Information
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NPI Number | 1689730616
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Entity Type | Individual
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Provider Name | CAROL D CRISP PHD, MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 3312 GATEWAY ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1054
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Country | US
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Telephone | 541-204-4745
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Fax |
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Provider Business Mailing Address
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Address Line | 3265 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-275-6655
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP61599
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License Number State | ID
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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 | 10002835
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License Number State | OR
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