Healthcare Provider Details

I. General information

NPI: 1205919636
Provider Name (Legal Business Name): ANITA CRAWLEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0080
  • Fax: 716-323-0295
Mailing address:
  • Phone: 716-323-0080
  • Fax: 716-323-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380702
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number406983
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberF380702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: