1609153618 NPI number — MRS. PRISCILLA CROWDER

Table of content: MRS. PRISCILLA CROWDER (NPI 1609153618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609153618 NPI number — MRS. PRISCILLA CROWDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWDER
Provider First Name:
PRISCILLA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609153618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 NE 104TH AVE
Provider Second Line Business Mailing Address:
APT# N-107
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-4541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-980-5365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10313 SW 69TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-9103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-726-3698
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2011

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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