Provider Demographics
NPI:1073379020
Name:CRAWFORD, KISEMBO
Entity Type:Individual
Prefix:
First Name:KISEMBO
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 HARGROVE AVE APT 81
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2590
Mailing Address - Country:US
Mailing Address - Phone:909-272-7458
Mailing Address - Fax:
Practice Address - Street 1:6250 HARGROVE AVE APT 81
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2590
Practice Address - Country:US
Practice Address - Phone:909-272-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide