Healthcare Provider Details

I. General information

NPI: 1063819829
Provider Name (Legal Business Name): CARIANNE NICOLE CROWE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARIANNE NICOLE CUNNINGHAM PA-C

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 07/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LAS TABLAS ROAD SUITE B
TEMPLETON CA
93465
US

IV. Provider business mailing address

1320 LAS TABLAS ROAD SUITE B
TEMPLETON CA
93465
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5563
  • Fax: 805-434-5916
Mailing address:
  • Phone: 805-434-5563
  • Fax: 805-434-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: