Healthcare Provider Details

I. General information

NPI: 1497834436
Provider Name (Legal Business Name): MS. MARGARET ANN CRANDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 UNIVERSITY DR APT 7
EDWARDSVILLE IL
62025-3966
US

IV. Provider business mailing address

1144 UNIVERSITY DR APT 7
EDWARDSVILLE IL
62025-3966
US

V. Phone/Fax

Practice location:
  • Phone: 801-668-0128
  • Fax:
Mailing address:
  • Phone: 801-668-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: