Healthcare Provider Details

I. General information

NPI: 1457988016
Provider Name (Legal Business Name): JULIE CROUSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 PENNSYLVANIA AVE STE C
FAIRFIELD CA
94533-3509
US

IV. Provider business mailing address

3157 DIABLO VIEW RD
LAFAYETTE CA
94549-2202
US

V. Phone/Fax

Practice location:
  • Phone: 707-428-4878
  • Fax:
Mailing address:
  • Phone: 925-239-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014293
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number358485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: