Healthcare Provider Details

I. General information

NPI: 1316909187
Provider Name (Legal Business Name): ALISSA PAULA CRAFT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

IV. Provider business mailing address

136 SW WASHINGTON AVE APT 402
CORVALLIS OR
97333-4877
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4906
  • Fax: 541-768-4907
Mailing address:
  • Phone: 602-770-8967
  • Fax: 541-768-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: