Healthcare Provider Details

I. General information

NPI: 1588470561
Provider Name (Legal Business Name): JENNIFER LYNN CRANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 GOHEEN ST
LEWISBURG WV
24901-1661
US

IV. Provider business mailing address

159 CICARA WAY
LEWISBURG WV
24901-1239
US

V. Phone/Fax

Practice location:
  • Phone: 304-520-0182
  • Fax: 304-647-5373
Mailing address:
  • Phone: 304-992-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: