Provider Demographics
NPI:1982305421
Name:CRABBE, ALISHA AMANDA
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:AMANDA
Last Name:CRABBE
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 1:3304 MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6402
Mailing Address - Country:US
Mailing Address - Phone:980-422-1235
Mailing Address - Fax:
Practice Address - Street 1:6331 CARMEL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8282
Practice Address - Country:US
Practice Address - Phone:704-724-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC271695163W00000X
NC5017932363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse