Provider Demographics
NPI:1043093669
Name:CRAWFORD, AMANDA ELIZABETH (STUDENT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S RIVERSIDE RD APT 7 BLDG 5
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-3013
Mailing Address - Country:US
Mailing Address - Phone:314-680-2980
Mailing Address - Fax:
Practice Address - Street 1:2121 S RIVERSIDE RD APT 7 BLDG 5
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-3013
Practice Address - Country:US
Practice Address - Phone:314-680-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program