=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821726357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA ANN CRAWFORD STNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2022
-----------------------------------------------------
Last Update Date | 08/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7905 GRAND DIVISION AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-288-4949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7905 GRAND DIVISION AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-288-4949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 365251770691
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------