Basic Information
| Provider Information | |||||||||
| NPI: | 1477675874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRISP | ||||||||
| FirstName: | CATRINA | ||||||||
| MiddleName: | CARLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | STE C | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534731 | ||||||||
| FaxNumber: | 5138528525 | ||||||||
| Practice Location | |||||||||
| Address1: | 7759 UNIVERSITY DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134634300 | ||||||||
| FaxNumber: | 5134634310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35-094121 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | 35.094121 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3038457 | 05 | OH | MEDICAID |