Provider Demographics
NPI:1508979220
Name:CRANDALL, MICHELLE D (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-0711
Mailing Address - Country:US
Mailing Address - Phone:401-539-0600
Mailing Address - Fax:401-539-0676
Practice Address - Street 1:1171 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02898
Practice Address - Country:US
Practice Address - Phone:401-539-0600
Practice Address - Fax:401-539-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPNS00021163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health