Provider Demographics
NPI:1487982500
Name:CRAWFORD, MARY ANN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 CLEARVISTA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1698
Mailing Address - Country:US
Mailing Address - Phone:317-621-4300
Mailing Address - Fax:317-621-4301
Practice Address - Street 1:7229 CLEARVISTA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1698
Practice Address - Country:US
Practice Address - Phone:317-621-4300
Practice Address - Fax:317-621-4301
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003067A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200975280Medicaid
IN000000639942OtherANTHEM
IN000000639942OtherANTHEM