MEDICARE: KEYANA CRAWFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	322274	NY

General Provider Information

NPI Number	:	1134593270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYANA CRAWFORD

Provider Business Mailing Address
First Line	:	PO BOX 64614
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-7014
Country	:	US
Telephone Number	:	585-465-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 SAWYER ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14619-1924
Country	:	US
Telephone Number	:	585-465-4688
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PRACTICAL NURSE
Name	:	KEYANA CRAWFORD
Credential	:	LPN
Telephone Number	:	585-465-4688

Provider Enumeration Date	:	11/29/2015
Last Update Date	:	11/29/2015

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