1033675004 NPI number — TRUMON OTTO CRAFT IV MSN, A-GNP

Table of content: TRUMON OTTO CRAFT IV MSN, A-GNP (NPI 1033675004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033675004 NPI number — TRUMON OTTO CRAFT IV MSN, A-GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAFT
Provider First Name:
TRUMON
Provider Middle Name:
OTTO
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
MSN, A-GNP
Provider Gender Code:
M

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:
1033675004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIFLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81650-2332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-625-5521
Provider Business Mailing Address Fax Number:
970-625-9336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIFLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81650-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-625-5521
Provider Business Practice Location Address Fax Number:
970-625-9336
Provider Enumeration Date:
02/14/2019

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: 363LA2200X , with the licence number:  0995336-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WC0200X , with the licence number: RN.0169891 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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