Provider Demographics
NPI:1164403630
Name:CRAWFORD, ANNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S RYAN ST
Mailing Address - Street 2:101
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-439-0762
Mailing Address - Fax:337-436-8862
Practice Address - Street 1:555 S RYAN ST
Practice Address - Street 2:101
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-439-0762
Practice Address - Fax:337-436-8862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN063236AP03561363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1569186Medicaid
LA1569186Medicaid
4B429Medicare ID - Type Unspecified