Provider Demographics
NPI:1356783815
Name:CRAWFORD, MAXINE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:MAXINE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3258 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1334
Mailing Address - Country:US
Mailing Address - Phone:716-832-0875
Mailing Address - Fax:716-832-4836
Practice Address - Street 1:3258 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1334
Practice Address - Country:US
Practice Address - Phone:716-832-0875
Practice Address - Fax:716-832-4836
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307521-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health