=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477435097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AYANA CRANK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2307 N ROLLING RD 25
-----------------------------------------------------
City | WINDSOR MILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-402-8951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5961 DUVEL ST
-----------------------------------------------------
City | IJAMSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21754-9649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-743-5641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 453123
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------