Provider Demographics
NPI:1295987386
Name:CRAWFORD, PEARLENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PEARLENE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MR
Other - First Name:ELIJAH
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4455 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2406
Mailing Address - Country:US
Mailing Address - Phone:347-431-4631
Mailing Address - Fax:347-431-4631
Practice Address - Street 1:4455 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2406
Practice Address - Country:US
Practice Address - Phone:347-431-4631
Practice Address - Fax:347-431-4631
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094475-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPROVIDER I.D.0222608Medicaid