Provider Demographics
NPI:1053154088
Name:CRUM, KRISTI JEAN LEE
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:JEAN LEE
Last Name:CRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:ESMOND
Mailing Address - State:ND
Mailing Address - Zip Code:58332-0052
Mailing Address - Country:US
Mailing Address - Phone:720-366-9399
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 52
Practice Address - Street 2:
Practice Address - City:ESMOND
Practice Address - State:ND
Practice Address - Zip Code:58332-0052
Practice Address - Country:US
Practice Address - Phone:720-366-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider