Provider Demographics
NPI:1801309091
Name:CRAWFORD, PENNY L (RN)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RN
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 98382
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8382
Mailing Address - Country:US
Mailing Address - Phone:253-389-6040
Mailing Address - Fax:
Practice Address - Street 1:5424 57TH AVE CT. W.
Practice Address - Street 2:G8
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467
Practice Address - Country:US
Practice Address - Phone:253-389-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60391176163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice