Healthcare Provider Details

I. General information

NPI: 1639539836
Provider Name (Legal Business Name): MS. WANDA CRANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA L STANDIFER

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S VIENNA ST
RUSTON LA
71270-5829
US

IV. Provider business mailing address

150 BUTLER RD
SIMSBORO LA
71275-3584
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-9200
  • Fax:
Mailing address:
  • Phone: 318-607-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: