Provider Demographics
NPI:1447821327
Name:CROWLEY, MIRANDA THERESE (RD, LD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:THERESE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W COMO AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1026
Mailing Address - Country:US
Mailing Address - Phone:216-554-2562
Mailing Address - Fax:
Practice Address - Street 1:2780 AIRPORT DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2289
Practice Address - Country:US
Practice Address - Phone:614-645-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered