Individual
HEIDI K CRULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
2115 S FREMONT AVE, STE 3300, SPRINGFIELD, MO 65804-2239
(417) 820-5200
(417) 820-5220
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4414
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2011040496
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10132814257
—
MO
05
—
191534758
—
AR
01
—
431560263
TRICARE
MO
01
—
P01036357
RR MCR
MO
Enumeration date
03/02/2012
Last updated
07/05/2012
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