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Individual

TERESA D CRUDUP

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNA

Contact information

Practice address
103 ROAMING FAWN DR, ROCKWOOD, TN 37854-4871
(865) 318-6865
(865) 285-9612
Mailing address
103 ROAMING FAWN DR, ROCKWOOD, TN 37854-4871
(865) 318-6865
(865) 285-9612

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
00149507
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
629114300
DEPARTMENT OF LABOR PROVIDER NUMBER DEEOIC
TN
Enumeration date
04/29/2022
Last updated
04/29/2022
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