Healthcare Provider Details

I. General information

NPI: 1477726503
Provider Name (Legal Business Name): SUZANNE XANTHE CRAWFORD RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MOORE AVE
CLAREMORE OK
74017-5047
US

IV. Provider business mailing address

101 S MOORE AVE
CLAREMORE OK
74017-5047
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-6314
  • Fax: 918-341-3627
Mailing address:
  • Phone: 918-342-6314
  • Fax: 918-341-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: