Provider Demographics
NPI:1588434088
Name:CRUM, BRANDEN (STNA)
Entity type:Individual
Prefix:MR
First Name:BRANDEN
Middle Name:
Last Name:CRUM
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GEORGETOWN AVE APT F11
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3823
Mailing Address - Country:US
Mailing Address - Phone:440-308-9369
Mailing Address - Fax:
Practice Address - Street 1:525 GEORGETOWN AVE APT F11
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3823
Practice Address - Country:US
Practice Address - Phone:440-308-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602772761223376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide