Individual
MEGAN CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
2995 N SALISBURY ST, WEST LAFAYETTE, IN 47906-1435
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
97772
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000553141
ANTHEM PROVIDER NUMBER
IN
Enumeration date
02/18/2008
Last updated
03/13/2008
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