Provider Demographics
NPI:1437508959
Name:CRANE, JENNIFER META (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:META
Last Name:CRANE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 GREEN VALLEY CIR
Mailing Address - Street 2:UNIT 201
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7041
Mailing Address - Country:US
Mailing Address - Phone:310-490-3631
Mailing Address - Fax:
Practice Address - Street 1:46 LAKE DR
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964
Practice Address - Country:US
Practice Address - Phone:310-490-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist