Individual
LESA A CRAWFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 310, FORT WAYNE, IN 46845-1733
(260) 266-5230
(260) 266-5238
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002162A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000672230
ANTHEM
IN
05
—
200820400
—
IN
Enumeration date
08/17/2006
Last updated
10/17/2022
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