Provider Demographics
NPI:1205919636
Name:CRAWLEY, ANITA (PNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0080
Mailing Address - Fax:716-323-0295
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0080
Practice Address - Fax:716-323-0295
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406983163W00000X
NYF3807022080P0206X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560684001OtherBC/BS
NY00027166101OtherUNIVERA
NY02244484Medicaid
0018168500001OtherPA MEDICAID
NY5111042OtherIHA
NY040426002817OtherFIDELIS
DD3424Medicare UPIN
NY040426002817OtherFIDELIS