Provider Demographics
NPI:1538416458
Name:CREWS, KEONA MONIQUE
Entity type:Individual
Prefix:
First Name:KEONA
Middle Name:MONIQUE
Last Name:CREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2123
Mailing Address - Country:US
Mailing Address - Phone:315-601-4328
Mailing Address - Fax:
Practice Address - Street 1:481 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2123
Practice Address - Country:US
Practice Address - Phone:315-601-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292025164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse