Provider Demographics
NPI:1518378819
Name:CROWDER, MESHAREESE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:MESHAREESE
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 MAGELLAN WAY
Mailing Address - Street 2:103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8101
Mailing Address - Country:US
Mailing Address - Phone:678-650-8612
Mailing Address - Fax:
Practice Address - Street 1:5715 MAGELLAN WAY
Practice Address - Street 2:103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8101
Practice Address - Country:US
Practice Address - Phone:678-650-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management