Provider Demographics
NPI:1801029491
Name:CRANDALL, ROLLA (TM)
Entity Type:Individual
Prefix:
First Name:ROLLA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 IDAHO AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1781
Mailing Address - Country:US
Mailing Address - Phone:612-735-0396
Mailing Address - Fax:
Practice Address - Street 1:7033 IDAHO AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1781
Practice Address - Country:US
Practice Address - Phone:612-735-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay