Provider Demographics
NPI:1861545659
Name:CRANK, DONNA (SW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CRANK
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 COMANCHE RD NE
Mailing Address - Street 2:MCKINLEY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1176
Mailing Address - Country:US
Mailing Address - Phone:505-881-9390
Mailing Address - Fax:
Practice Address - Street 1:4500 COMANCHE RD NE
Practice Address - Street 2:MCKINLEY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1176
Practice Address - Country:US
Practice Address - Phone:505-881-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 049961041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37474863Medicaid