Provider Demographics
NPI:1972258804
Name:CRYER, PRITANICA I
Entity type:Individual
Prefix:
First Name:PRITANICA
Middle Name:I
Last Name:CRYER
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 1:7939 JEFFERSON HWY APT A102
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1201
Mailing Address - Country:US
Mailing Address - Phone:225-892-0539
Mailing Address - Fax:
Practice Address - Street 1:7939 JEFFERSON HWY APT A102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1201
Practice Address - Country:US
Practice Address - Phone:225-892-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010187048172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver