Provider Demographics
NPI:1093569733
Name:CRESPO, NORMA ELAINE (RN)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:ELAINE
Last Name:CRESPO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:ELAINE
Other - Last Name:MIGHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1534 CRESCENT LN APT K
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4695
Mailing Address - Country:US
Mailing Address - Phone:919-696-9223
Mailing Address - Fax:
Practice Address - Street 1:2563 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1715
Practice Address - Country:US
Practice Address - Phone:404-699-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty