Provider Demographics
NPI:1033206784
Name:CRANE, CHRISTINA REESE (CFNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:REESE
Last Name:CRANE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LOUISE
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-238-8073
Practice Address - Fax:706-238-8081
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA828085531BMedicaid
GA828085531BMedicaid
Q72380Medicare UPIN