Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP-03578 | OH |
NPI | 1225068489 |
---|---|
Provider Name | Mrs. Carol Jean Crawford |
First Address | Canton, OH 44710-1702 |
Second Address | Canton, OH 44710-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 03/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2171699 | (05) | OH |
XXXXXXXXXX | ? ON FILE AT WORK (01) |