Provider Demographics
NPI:1114767647
Name:CRAWLEY, JON B
Entity type:Individual
Prefix:
First Name:JON
Middle Name:B
Last Name:CRAWLEY
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 1:112 ECLIPSE CT APT 5
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5440
Mailing Address - Country:US
Mailing Address - Phone:304-240-2940
Mailing Address - Fax:
Practice Address - Street 1:112 ECLIPSE CT APT 5
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5440
Practice Address - Country:US
Practice Address - Phone:304-240-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant