MEDICARE: MALEAH ABIGAIL 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134941677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALEAH ABIGAIL CRAWFORD

Provider Business Mailing Address
First Line	:	5845 E 22ND ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-2315
Country	:	US
Telephone Number	:	405-761-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	5845 E 22ND ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-2315
Country	:	US
Telephone Number	:	405-761-7889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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