Provider Demographics
NPI:1831771302
Name:CRAWFORD, CANDACE REBEKKA (CNA-MT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:REBEKKA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CNA-MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 WEBBER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6122
Mailing Address - Country:US
Mailing Address - Phone:207-320-9986
Mailing Address - Fax:
Practice Address - Street 1:257 WEBBER AVE APT 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6122
Practice Address - Country:US
Practice Address - Phone:207-320-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health