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Individual
MIRANDA WALLACE CRAWFORD
Active
Individual
MIRANDA WALLACE CRAWFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN192423
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003132174A
—
GA
05
—
NP2325
—
SC
01
—
RN192426
LICENSE
GA
Enumeration date
02/22/2013
Last updated
05/12/2014
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