Provider Demographics
NPI:1427827047
Name:CRAWLEY, TRACEY DENISE (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:DENISE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19403 GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2123
Mailing Address - Country:US
Mailing Address - Phone:313-348-3628
Mailing Address - Fax:
Practice Address - Street 1:19813 KELLY RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1913
Practice Address - Country:US
Practice Address - Phone:313-348-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home