Healthcare Provider Details

I. General information

NPI: 1144984923
Provider Name (Legal Business Name): MONICA CROWE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SAHARA TRL
POLAND OH
44514-3687
US

IV. Provider business mailing address

725 S HUBBARD RD
LOWELLVILLE OH
44436-9754
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: