Individual
MISS BAABA CRAYNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
839 SUFFOLK AVE, BRENTWOOD, NY 11717-4403
(631) 639-4637
Mailing address
1549 HECKSCHER AVE, BAY SHORE, NY 11706-2408
(631) 639-4637
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
330679-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9037483617
1199 SEIU
—
Enumeration date
04/06/2018
Last updated
04/06/2018
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