MEDICARE: JANETTA DELORES CROWSON

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	:	1881880383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTA DELORES CROWSON

Provider Business Mailing Address
First Line	:	PO BOX 2791
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27216-2791
Country	:	US
Telephone Number	:	336-675-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 CALHOUN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2562
Country	:	US
Telephone Number	:	803-691-0174
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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