Provider Demographics
NPI:1699665661
Name:CRAWFORD, DALLAS (BSN, RN)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18874 N IBIS WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2981
Mailing Address - Country:US
Mailing Address - Phone:916-308-5974
Mailing Address - Fax:
Practice Address - Street 1:19845 N COSTA DEL SOL
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5431
Practice Address - Country:US
Practice Address - Phone:520-568-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ322144163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse