Provider Demographics
NPI:1598244915
Name:CRAWFORD, TINA I (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:I
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-7833
Mailing Address - Country:US
Mailing Address - Phone:309-382-2006
Mailing Address - Fax:309-382-2007
Practice Address - Street 1:2079 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-7833
Practice Address - Country:US
Practice Address - Phone:309-382-2006
Practice Address - Fax:309-382-2007
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.320339163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult