Healthcare Provider Details

I. General information

NPI: 1467744458
Provider Name (Legal Business Name): CRYSTAL DRAKE CST FA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 CANTERBURY ST
EUGENE OR
97404-1975
US

IV. Provider business mailing address

2481 CANTERBURY ST
EUGENE OR
97404-1975
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-2138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: