Provider Demographics
NPI:1952083594
Name:CRAWFORD, RANECA FAYETTE
Entity Type:Individual
Prefix:
First Name:RANECA
Middle Name:FAYETTE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4066
Mailing Address - Country:US
Mailing Address - Phone:937-312-7968
Mailing Address - Fax:
Practice Address - Street 1:1720 KENTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-3304
Practice Address - Country:US
Practice Address - Phone:937-450-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant