Provider Demographics
NPI:1225662737
Name:CRAWFORD, ANNA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RDN, LDN
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 772
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-0772
Mailing Address - Country:US
Mailing Address - Phone:217-721-4042
Mailing Address - Fax:
Practice Address - Street 1:44 E MAIN ST STE 406
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3649
Practice Address - Country:US
Practice Address - Phone:217-721-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-03-25
Deactivation Date:2020-07-13
Deactivation Code:
Reactivation Date:2024-03-25
Provider Licenses
StateLicense IDTaxonomies
IL164.004642133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000000OtherN/A