Provider Demographics
NPI:1760206171
Name:CRISP, GREGORY ALAN
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:CRISP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 STATE ROUTE 373
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8863
Mailing Address - Country:US
Mailing Address - Phone:740-442-8405
Mailing Address - Fax:
Practice Address - Street 1:470 STATE ROUTE 373
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-8863
Practice Address - Country:US
Practice Address - Phone:740-442-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide