Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | MO |
NPI | 1467075762 |
---|---|
Provider Name | Mrs. Yolande J Crawford |
First Address | O Fallon, MO 63366-9255 |
Second Address | O Fallon, MO 63366-3961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2020 |
Last Update Date | 20/05/2020 |