Healthcare Provider Details

I. General information

NPI: 1538864780
Provider Name (Legal Business Name): EMMA CROWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 FOWLER LN STE 204
DIAMOND SPRINGS CA
95619-9782
US

IV. Provider business mailing address

4250 FOWLER LN STE 204
DIAMOND SPRINGS CA
95619-9782
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-1491
  • Fax:
Mailing address:
  • Phone: 916-280-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: