Provider Demographics
NPI:1750309399
Name:CRAWFORD, MARCI J (CNP)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N GUADALUPE ST
Mailing Address - Street 2:C1-C2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6510
Mailing Address - Country:US
Mailing Address - Phone:505-913-4660
Mailing Address - Fax:505-913-4660
Practice Address - Street 1:510 N GUADALUPE ST
Practice Address - Street 2:C1-C2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6510
Practice Address - Country:US
Practice Address - Phone:505-913-4660
Practice Address - Fax:505-913-4660
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR40537207Q00000X
NMCNP00905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000P3426Medicaid
S28478Medicare UPIN
NM000P3426Medicaid