1467732990 NPI number — MRS. PAIGE KATHLEEN CROZIER ARNP

Table of content: MRS. PAIGE KATHLEEN CROZIER ARNP (NPI 1467732990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467732990 NPI number — MRS. PAIGE KATHLEEN CROZIER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROZIER
Provider First Name:
PAIGE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESHISHNEK
Provider Other First Name:
PAIGE
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467732990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 NW HILL POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97703-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-254-7477
Provider Business Mailing Address Fax Number:
541-883-4213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3314 VANDENBERG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97603-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-882-7291
Provider Business Practice Location Address Fax Number:
541-883-4213
Provider Enumeration Date:
08/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  201150105NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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