Provider Demographics
NPI:1952903668
Name:CRENNEL, MAKIEA MICHAE' (NP-C)
Entity type:Individual
Prefix:
First Name:MAKIEA
Middle Name:MICHAE'
Last Name:CRENNEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 KEMPSVILLE CIR STE 315
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3935
Mailing Address - Country:US
Mailing Address - Phone:757-461-5400
Mailing Address - Fax:757-461-3305
Practice Address - Street 1:6161 KEMPSVILLE CIR STE 315
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3935
Practice Address - Country:US
Practice Address - Phone:757-461-5400
Practice Address - Fax:757-461-3305
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily