Provider Demographics
NPI:1710924477
Name:MOLINA, CHANITA CRAWLEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHANITA
Middle Name:CRAWLEY
Last Name:MOLINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHANITA
Other - Middle Name:D
Other - Last Name:CRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-01748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003833Medicaid
NC7866890OtherAETNA
NC192928OtherMEDCOST
NC7003833Medicaid
NC192928OtherMEDCOST