Basic Information
| Provider Information | |||||||||
| NPI: | 1154540391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROOKS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRIGHTMAN | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 444 BOYCE ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430781461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376522822 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1150 SCIOTO ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430782291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376524555 | ||||||||
| FaxNumber: | 9376524945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374T00000X | PN110857 | OH | Y | Nursing Service Related Providers | Religious Nonmedical Nursing Personnel |
No ID Information.