Provider Demographics
NPI:1093232027
Name:CRAWLEY, TIA MONIQUE (LPN)
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:MONIQUE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4006
Mailing Address - Country:US
Mailing Address - Phone:804-481-1804
Mailing Address - Fax:
Practice Address - Street 1:308 S BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23602-4006
Practice Address - Country:US
Practice Address - Phone:804-481-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002087733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse