Healthcare Provider Details

I. General information

NPI: 1487479812
Provider Name (Legal Business Name): JOHN CROWE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31292 ALPINE MEADOWS RD
SHINGLETOWN CA
96088-9462
US

IV. Provider business mailing address

2039 GLENROSE DR
REDDING CA
96001-4942
US

V. Phone/Fax

Practice location:
  • Phone: 530-474-3390
  • Fax:
Mailing address:
  • Phone: 209-289-9425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number839239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: