MEDICARE: MS. PATRECE CHANTAE CRAWFORD L.P.N

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	408221	OH

General Provider Information

NPI Number	:	1831222553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRECE CHANTAE CRAWFORD L.P.N

Provider Business Mailing Address
First Line	:	13418 ERSTCROFT CT
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-7841
Country	:	US
Telephone Number	:	614-515-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 CHANNINGWAY BLVD
Second Line	:	SUITE 700
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2910
Country	:	US
Telephone Number	:	614-751-7777
Fax Number	:	614-751-7770

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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