Healthcare Provider Details

I. General information

NPI: 1578975009
Provider Name (Legal Business Name): NATHANIEL CRANNEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROSE BARRACKS, BUILDING 260
VILSECK BAYERN
92249
DE

IV. Provider business mailing address

CMR 411 BOX 2791
APO AE
09112-0028
US

V. Phone/Fax

Practice location:
  • Phone: 63-719-4642
  • Fax:
Mailing address:
  • Phone: 801-341-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1367
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: