Healthcare Provider Details

I. General information

NPI: 1174988778
Provider Name (Legal Business Name): GREGORY MICHAEL CRAWFORD C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

104 FAHEY CT
FOLSOM CA
95630-8049
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2000
  • Fax:
Mailing address:
  • Phone: 775-240-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: