Provider Demographics
NPI:1912424409
Name:CRANDALL, NATALIE MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:MARIE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 IVY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-4661
Mailing Address - Country:US
Mailing Address - Phone:314-609-1058
Mailing Address - Fax:
Practice Address - Street 1:3920 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1401
Practice Address - Country:US
Practice Address - Phone:844-776-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017019299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily