Healthcare Provider Details

I. General information

NPI: 1467143123
Provider Name (Legal Business Name): VENUS CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 TRINITY MILLS RD APT 2114
DALLAS TX
75287-6245
US

IV. Provider business mailing address

3637 TRINITY MILLS RD APT 2114
DALLAS TX
75287-6245
US

V. Phone/Fax

Practice location:
  • Phone: 214-444-1543
  • Fax:
Mailing address:
  • Phone: 214-444-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: