Healthcare Provider Details

I. General information

NPI: 1407268899
Provider Name (Legal Business Name): BRANDI K.C. CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-137 KAWAIPUNA ST
HAUULA HI
96717-9511
US

IV. Provider business mailing address

PO BOX 899
HAUULA HI
96717-0899
US

V. Phone/Fax

Practice location:
  • Phone: 808-779-0473
  • Fax:
Mailing address:
  • Phone: 808-779-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104100000X
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: