Healthcare Provider Details

I. General information

NPI: 1548938244
Provider Name (Legal Business Name): ZACHARY ALAN CROUCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 570
EUGENE OR
97401-8168
US

IV. Provider business mailing address

PO BOX 2426
PERRIS CA
92572-2426
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7070
  • Fax: 541-687-6214
Mailing address:
  • Phone: 951-956-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10063083
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95200789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: