Provider Demographics
NPI:1760014021
Name:CRAWLEY, MAKENZE LYNNE
Entity Type:Individual
Prefix:
First Name:MAKENZE
Middle Name:LYNNE
Last Name:CRAWLEY
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 1:1201 S BROOK ST APT 307
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2919
Mailing Address - Country:US
Mailing Address - Phone:772-285-7225
Mailing Address - Fax:
Practice Address - Street 1:1201 S BROOK ST APT 307
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2919
Practice Address - Country:US
Practice Address - Phone:772-285-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program