MEDICARE: LINDSEY LEARY CRANDALL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	9580	AZ

General Provider Information

NPI Number	:	1457861940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY LEARY CRANDALL PA

Provider Business Mailing Address
First Line	:	12138 POWER RD
Second Line	:
City	:	QUANTICO
State	:	VA
Zip	:	22134-2008
Country	:	US
Telephone Number	:	386-490-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	3875 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-225-0584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	07/17/2023

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Directions to “ LINDSEY LEARY CRANDALL PA” Practice Location

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