Provider Demographics
NPI:1104525864
Name:CRUMB, EVELYN SUZANNE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:SUZANNE
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 1:3808 US 21 HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-7313
Mailing Address - Country:US
Mailing Address - Phone:315-750-5047
Mailing Address - Fax:
Practice Address - Street 1:601 S MARTIN LUTHER KING JR DR FL 432
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27110-0003
Practice Address - Country:US
Practice Address - Phone:336-750-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program