Healthcare Provider Details

I. General information

NPI: 1518378819
Provider Name (Legal Business Name): MESHAREESE CROWDER CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 MAGELLAN WAY 103
RALEIGH NC
27612-8101
US

IV. Provider business mailing address

5715 MAGELLAN WAY 103
RALEIGH NC
27612-8101
US

V. Phone/Fax

Practice location:
  • Phone: 678-650-8612
  • Fax:
Mailing address:
  • Phone: 678-650-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: