=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336426972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. PATRICK FRANCIS CROW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2011
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34800 VINE ST APT. 106E
-----------------------------------------------------
City | WILLOWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44095-5122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-527-3942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34800 VINE ST APT. 106E
-----------------------------------------------------
City | WILLOWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44095-5122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-527-3942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 18005825908
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------