Provider Demographics
NPI:1831222553
Name:CRAWFORD, PATRECE CHANTAE (LPN)
Entity type:Individual
Prefix:MS
First Name:PATRECE
Middle Name:CHANTAE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 ERSTCROFT CT
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7841
Mailing Address - Country:US
Mailing Address - Phone:614-515-0635
Mailing Address - Fax:
Practice Address - Street 1:6100 CHANNINGWAY BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2910
Practice Address - Country:US
Practice Address - Phone:614-751-7777
Practice Address - Fax:614-751-7770
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH408221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse