MEDICARE: DR. NATHAN CRAPO

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	1835G0303X	Geriatric Pharmacist	S022388	AZ

General Provider Information

NPI Number	:	1477208767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN CRAPO

Provider Business Mailing Address
First Line	:	8612 E OLLA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-1577
Country	:	US
Telephone Number	:	480-369-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 E COVEY LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5674
Country	:	US
Telephone Number	:	623-815-8965
Fax Number	:	623-815-1222

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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