Individual
CAROL D CRISP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MSN, FNP-BC
Contact information
Practice address
3312 GATEWAY ST, SPRINGFIELD, OR 97477-1054
(541) 204-4745
Mailing address
3265 HILLCREST PARK DR, MEDFORD, OR 97504-7657
(541) 275-6655
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10002835
OR
363LF0000X
Family Nurse Practitioner
CNP61599
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002835
STATE LICENSE
OR
01
—
CNP61599
STATE LICENSE
ID
Enumeration date
12/27/2006
Last updated
07/27/2023
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