Provider Demographics
NPI:1467686154
Name:CRANDALL, HAYLEY MICHELLE (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:MICHELLE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:49TH MEDICAL GROUP/SGPF
Mailing Address - Street 2:280 FIRST STREET, BLDG 23
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-2446
Mailing Address - Fax:575-572-2259
Practice Address - Street 1:49TH MEDICAL GROUP/SGPF
Practice Address - Street 2:280 FIRST STREET, BLDG 23
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-2446
Practice Address - Fax:575-572-2259
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians