MEDICARE: GINA M. CRUSOR-PRICE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71014056A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487608428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA M. CRUSOR-PRICE FNP-BC

Provider Business Mailing Address
First Line	:	17112 CALIFORNIA AVE
Second Line	:
City	:	HAZEL CREST
State	:	IL
Zip	:	60429-1118
Country	:	US
Telephone Number	:	708-253-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	9008 INDIANAPOLIS BLVD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2501
Country	:	US
Telephone Number	:	219-513-8923
Fax Number	:	219-513-8941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	06/28/2023

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