Individual
PENELOPE ANN CRISP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-6637
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-6637
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
000900293
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000903
—
NC
01
—
7652648
AETNA
NC
01
—
B3908
MEDCOST
NC
Enumeration date
12/08/2005
Last updated
11/12/2010
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