Provider Demographics
NPI:1851721435
Name:CRANDALL, PENNY (LPN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BELL LN
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-8524
Mailing Address - Country:US
Mailing Address - Phone:607-838-0030
Mailing Address - Fax:
Practice Address - Street 1:41 BELL LN
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-8524
Practice Address - Country:US
Practice Address - Phone:607-838-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299010164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse