Healthcare Provider Details

I. General information

NPI: 1255013868
Provider Name (Legal Business Name): JOHN EDWARD CRUTCHLOW JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 E COUNTY LINE RD STE B-665
CENTENNIAL CO
80112-3527
US

IV. Provider business mailing address

835 W WARNER RD #101 PMB 111
GILBERT AZ
85233
US

V. Phone/Fax

Practice location:
  • Phone: 520-664-6164
  • Fax:
Mailing address:
  • Phone: 520-664-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number285908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: