Provider Demographics
NPI:1528204625
Name:CRAWFORD, JENNIFER MAGEN (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAGEN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DAY LN
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9660
Mailing Address - Country:US
Mailing Address - Phone:501-581-1175
Mailing Address - Fax:
Practice Address - Street 1:18 DAY LN
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9660
Practice Address - Country:US
Practice Address - Phone:501-581-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL47140164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse