Healthcare Provider Details

I. General information

NPI: 1013493550
Provider Name (Legal Business Name): ASHLEY WALL CRAWFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PINNACLE PKWY
ELGIN SC
29045-8390
US

IV. Provider business mailing address

45 LEATHERWOOD DR
LUGOFF SC
29078-7107
US

V. Phone/Fax

Practice location:
  • Phone: 803-424-8022
  • Fax:
Mailing address:
  • Phone: 180-324-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22046
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: