1386171114 NPI number — DR. PAULINE CROUCH N.D.

Table of content: DR. PAULINE CROUCH N.D. (NPI 1386171114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386171114 NPI number — DR. PAULINE CROUCH N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROUCH
Provider First Name:
PAULINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROUCH
Provider Other First Name:
SEROYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386171114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUTNEY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05346-0355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-387-0124
Provider Business Mailing Address Fax Number:
802-419-3790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MAIN ST
Provider Second Line Business Practice Location Address:
LEVEL 2
Provider Business Practice Location Address City Name:
PUTNEY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-387-0124
Provider Business Practice Location Address Fax Number:
802-387-3970
Provider Enumeration Date:
05/11/2017

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: 175F00000X , with the licence number:  639 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: 099.0129466 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com