Provider Demographics
NPI:1417446410
Name:CRAWN, WILLARD JAMES IV (RN)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:JAMES
Last Name:CRAWN
Suffix:IV
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3854
Mailing Address - Country:US
Mailing Address - Phone:315-738-6147
Mailing Address - Fax:315-738-4403
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-6147
Practice Address - Fax:315-738-4403
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse