Provider Demographics
NPI:1629751888
Name:CREW, LICHELLE
Entity Type:Individual
Prefix:
First Name:LICHELLE
Middle Name:
Last Name:CREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 ADISHIAN WAY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4423
Mailing Address - Country:US
Mailing Address - Phone:951-406-7140
Mailing Address - Fax:
Practice Address - Street 1:11762 DE PALMA RD STE 1C
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4010
Practice Address - Country:US
Practice Address - Phone:951-406-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95146744163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health