Healthcare Provider Details

I. General information

NPI: 1710649306
Provider Name (Legal Business Name): DEONNA CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N 75TH AVE
GLENDALE AZ
85303-2514
US

IV. Provider business mailing address

7111 N 75TH AVE
GLENDALE AZ
85303-2514
US

V. Phone/Fax

Practice location:
  • Phone: 928-233-1716
  • Fax:
Mailing address:
  • Phone: 928-233-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number251074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: