Provider Demographics
NPI:1487608428
Name:CRUSOR-PRICE, GINA M (FNP-BC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CRUSOR-PRICE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:CRUSOR-PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17112 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1118
Mailing Address - Country:US
Mailing Address - Phone:708-253-8205
Mailing Address - Fax:
Practice Address - Street 1:9008 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2501
Practice Address - Country:US
Practice Address - Phone:219-513-8923
Practice Address - Fax:219-513-8941
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014056A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132000Medicaid
INCA9280OMedicare PIN