Provider Demographics
NPI:1184338493
Name:CRIM, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:CRIM
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 1:941 BURT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-6031
Mailing Address - Country:US
Mailing Address - Phone:315-868-9566
Mailing Address - Fax:
Practice Address - Street 1:1 HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-9326
Practice Address - Country:US
Practice Address - Phone:315-823-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse