Provider Demographics
NPI:1659874741
Name:CRAWFORD, LAWANDA
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:CRAWFORD
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 1:1110 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4202
Mailing Address - Country:US
Mailing Address - Phone:972-230-8881
Mailing Address - Fax:972-230-8810
Practice Address - Street 1:1110 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4202
Practice Address - Country:US
Practice Address - Phone:972-230-8881
Practice Address - Fax:972-230-8810
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659874741Medicaid