Healthcare Provider Details

I. General information

NPI: 1225309743
Provider Name (Legal Business Name): LORENA CRANK M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 169 MILE MARKER 21 ALAMO NAVAJO SCHOOL BOARD INC.
ALAMO NM
87825
US

IV. Provider business mailing address

PO BOX 1254
MAGDALENA NM
87825-1254
US

V. Phone/Fax

Practice location:
  • Phone: 878-854-2626
  • Fax: 878-854-2616
Mailing address:
  • Phone: 575-854-2626
  • Fax: 575-854-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: