Healthcare Provider Details

I. General information

NPI: 1023953486
Provider Name (Legal Business Name): HANNA MYKAL CROZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S 8TH AVE
POCATELLO ID
83209-0002
US

IV. Provider business mailing address

70 E 2ND S
WESTON ID
83286-5036
US

V. Phone/Fax

Practice location:
  • Phone: 208-530-3692
  • Fax:
Mailing address:
  • Phone: 208-530-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberI71572
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: