Provider Demographics
NPI:1215768940
Name:CRUDDEN, GINA (DNP, APRN-CNS)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CRUDDEN
Suffix:
Gender:F
Credentials:DNP, APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 PARK CREST DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4449
Mailing Address - Country:US
Mailing Address - Phone:817-504-5024
Mailing Address - Fax:
Practice Address - Street 1:2210 PARK CREST DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-4449
Practice Address - Country:US
Practice Address - Phone:817-504-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM0101961364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology