Provider Demographics
NPI:1508979220
Name:CRANDALL, MICHELLE D (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:401-539-0600
Mailing Address - Fax:401-539-0676
Practice Address - Street 1:1052 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-461-5056
Practice Address - Fax:401-942-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPNS00021163WP0808X
APRN00185261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health