Provider Demographics
NPI:1215734231
Name:CRUMB, JOHANNA MARIE
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:CRUMB
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 S 78TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2230
Mailing Address - Country:US
Mailing Address - Phone:402-637-3774
Mailing Address - Fax:
Practice Address - Street 1:4715 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1899
Practice Address - Country:US
Practice Address - Phone:402-444-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider