1720348576 NPI number — MRS. ALLISON FOGG CRABTREE CRNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720348576 NPI number — MRS. ALLISON FOGG CRABTREE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRABTREE
Provider First Name:
ALLISON
Provider Middle Name:
FOGG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRABTREE
Provider Other First Name:
ELLA
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720348576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 AVALON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36207-8069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-283-2461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 LEIGHTON AVE., SUITE 407
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNISTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-741-6464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2012

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: 363LF0000X , with the licence number:  1-099726 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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