Provider Demographics
NPI:1366011488
Name:CREWS, LORRAINE MICHELLE
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MICHELLE
Last Name:CREWS
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 1:1739 INDEPENDENCE AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1637
Mailing Address - Country:US
Mailing Address - Phone:202-489-3018
Mailing Address - Fax:
Practice Address - Street 1:315 50TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7671
Practice Address - Country:US
Practice Address - Phone:202-200-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant