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General NPI Number Information
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NPI Number | 1467364380
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Entity Type | Organization
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Legal Business Name | CROWN N GLOW CRANIAL PROSTHESIS COMPANY
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 3911 SAUK TRL
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City | RICHTON PARK
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State | IL
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Zip | 60471-1339
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Country | US
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Telephone | 708-965-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 3911 SAUK TRL
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City | RICHTON PARK
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State | IL
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Zip | 60471-1339
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Country | US
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Telephone | 708-965-3118
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ISHA WARDELL
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Credential |
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Telephone | 708-724-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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