Basic Information
| Provider Information | |||||||||
| NPI: | 1457648388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CREASAP | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NORTHLAND BLVD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136723309 | ||||||||
| FaxNumber: | 5136723323 | ||||||||
| Practice Location | |||||||||
| Address1: | 6040 W 84TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462781360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179566228 | ||||||||
| FaxNumber: | 3179566289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 28196146A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.