Provider Demographics
NPI:1811663321
Name:CRANE, TERI MARIE
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:MARIE
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:MARIE
Other - Last Name:SELL, OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN NURSE
Mailing Address - Street 1:2210 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1019
Mailing Address - Country:US
Mailing Address - Phone:254-755-6411
Mailing Address - Fax:254-755-6422
Practice Address - Street 1:2210 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1019
Practice Address - Country:US
Practice Address - Phone:254-755-6411
Practice Address - Fax:254-755-6422
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125442164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse