Provider Demographics
NPI:1497313225
Name:CRAWFORD, MONA ROCHELLE
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:ROCHELLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:ROCHELLE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6209
Mailing Address - Country:US
Mailing Address - Phone:267-304-4787
Mailing Address - Fax:
Practice Address - Street 1:1209 LARCHMONT DR # 1209
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6209
Practice Address - Country:US
Practice Address - Phone:267-304-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00003862338347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle