Provider Demographics
NPI:1164081238
Name:CRAWFORD, THEERA BREANN (CERTIFIED NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:THEERA
Middle Name:BREANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77221-4410
Mailing Address - Country:US
Mailing Address - Phone:713-836-2092
Mailing Address - Fax:
Practice Address - Street 1:3723 WYOMING ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-4717
Practice Address - Country:US
Practice Address - Phone:832-362-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide