Basic Information
| Provider Information | |||||||||
| NPI: | 1780156935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | KENDELL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | APRN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 925 | ||||||||
| Address2: | |||||||||
| City: | STARKVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397600925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627695571 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3701 12TH ST N STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202583090 | ||||||||
| FaxNumber: | 3202583095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2018 | ||||||||
| LastUpdateDate: | 02/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 52386 | MN | N | Nursing Service Providers | Registered Nurse | 367500000X | 2470786 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.