Provider Demographics
NPI:1780361600
Name:CROWELL, STACEY H (CNA)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:H
Last Name:CROWELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FALLSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2104
Mailing Address - Country:US
Mailing Address - Phone:443-650-3050
Mailing Address - Fax:
Practice Address - Street 1:4 FALLSHIRE CT
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2104
Practice Address - Country:US
Practice Address - Phone:443-650-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNRSA-0066374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide