Individual
MICHAEL E CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNS
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2164
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
364SM0705X
Medical-Surgical Clinical Nurse Specialist
Primary
28074750A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000905209
ANTHEM PROVIDER NUMBER
IN
05
—
201262580
—
IN
Enumeration date
10/13/2014
Last updated
12/03/2020
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