Provider Demographics
NPI:1235843111
Name:CROWDER, CAPUCINE (CNA,HHA,PCA)
Entity Type:Individual
Prefix:MISS
First Name:CAPUCINE
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:CNA,HHA,PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3613
Mailing Address - Country:US
Mailing Address - Phone:312-535-1602
Mailing Address - Fax:
Practice Address - Street 1:1307 W 110TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3613
Practice Address - Country:US
Practice Address - Phone:312-535-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNA376K00000X, 374U00000X
NA3747P1801X
CONA0037871376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant