Provider Demographics
NPI:1548428303
Name:CRUM, SANDRA (CERTPS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:CERTPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 W MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 3005
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5014
Mailing Address - Country:US
Mailing Address - Phone:214-819-9911
Mailing Address - Fax:214-819-9944
Practice Address - Street 1:1545 W MOCKINGBIRD LN
Practice Address - Street 2:SUITE 3005
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5014
Practice Address - Country:US
Practice Address - Phone:214-819-9911
Practice Address - Fax:214-819-9944
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker