Provider Demographics
NPI:1629741897
Name:CREWS, DESA LEIGH (RD)
Entity Type:Individual
Prefix:MRS
First Name:DESA
Middle Name:LEIGH
Last Name:CREWS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E MONROE AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-3021
Mailing Address - Country:US
Mailing Address - Phone:336-455-0788
Mailing Address - Fax:
Practice Address - Street 1:625 E MONROE AVE APT 119
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-3021
Practice Address - Country:US
Practice Address - Phone:703-831-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86088359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty