Provider Demographics
NPI:1992779805
Name:CRAWFORD, CAROLE M (MS, RN, CS, APN)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS, RN, CS, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E SPAULDING AVE
Mailing Address - Street 2:BOX 11
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5416
Mailing Address - Country:US
Mailing Address - Phone:719-251-3346
Mailing Address - Fax:855-775-0361
Practice Address - Street 1:63 E SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5416
Practice Address - Country:US
Practice Address - Phone:719-251-3346
Practice Address - Fax:855-775-0361
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0001116.CNS364SP0808X
CO35314364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health