Provider Demographics
NPI:1063001121
Name:CRAWFORD, STACY NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DEPOT VIEW DR APT 12
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2779
Mailing Address - Country:US
Mailing Address - Phone:989-464-5923
Mailing Address - Fax:
Practice Address - Street 1:510 DEPOT VIEW DR APT 12
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2779
Practice Address - Country:US
Practice Address - Phone:989-464-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse