MEDICARE: REBECCA DIANE CRAWFORTH NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	69178	ID
2	363L00000X	Nurse Practitioner	10331826-4405	UT
3	363L00000X	Nurse Practitioner	NUR-APRN-LIC-183916	MT

General Provider Information

NPI Number	:	1053086348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DIANE CRAWFORTH NP-C

Provider Business Mailing Address
First Line	:	3775 S HIGHLAND DR
Second Line	:	SUITE 2
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106
Country	:	US
Telephone Number	:	801-884-8030
Fax Number	:

Provider Business Practice Location Address
First Line	:	3775 S HIGHLAND DR
Second Line	:	SUITE 2
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106
Country	:	US
Telephone Number	:	801-884-8030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	03/17/2026

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