Healthcare Provider Details

I. General information

NPI: 1649630153
Provider Name (Legal Business Name): DENISE ELAINE CRAWFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

13422 KINSMAN RD
CLEVELAND OH
44120-4492
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-4400
  • Fax: 216-283-9586
Mailing address:
  • Phone: 162-283-4400
  • Fax: 216-283-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number024374
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.288330
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN288330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: