Provider Demographics
NPI:1447979042
Name:CRUMB, EMILY CHERYL
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CHERYL
Last Name:CRUMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1135
Mailing Address - Country:US
Mailing Address - Phone:607-429-9955
Mailing Address - Fax:
Practice Address - Street 1:3905 SLATE HILL RD
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-9679
Practice Address - Country:US
Practice Address - Phone:315-380-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY778218163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine