Provider Demographics
NPI:1861975591
Name:CRANFORD, MARIAN ELAINE (PA)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:ELAINE
Last Name:CRANFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LORRAINE ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1117
Mailing Address - Country:US
Mailing Address - Phone:919-619-3535
Mailing Address - Fax:919-929-6911
Practice Address - Street 1:101 LORRAINE ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1117
Practice Address - Country:US
Practice Address - Phone:919-619-3535
Practice Address - Fax:919-929-6911
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant