Provider Demographics
NPI:1518440098
Name:CRAWFORD, DAVID JOSEPH CRUZ (LPN)
Entity type:Individual
Prefix:
First Name:DAVID JOSEPH
Middle Name:CRUZ
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LIBBY CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8603
Mailing Address - Country:US
Mailing Address - Phone:936-253-9113
Mailing Address - Fax:
Practice Address - Street 1:205 LIBBY CIR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8603
Practice Address - Country:US
Practice Address - Phone:936-253-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208160164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse