Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | RL14103 | ND |
Y | 111NI0900X | Internist | RL14103 | ND |
NPI | 1003269234 |
---|---|
Provider Name | Dr. Keri Lynn Crewson |
First Address | Fargo, ND 58122-0170 |
Second Address | Fargo, ND 58122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 18/06/2018 |