Healthcare Provider Details

I. General information

NPI: 1669576781
Provider Name (Legal Business Name): ANGELA MARIE CROTHERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 WILLAGILLESPIE RD
EUGENE OR
97401-2123
US

IV. Provider business mailing address

28465 SUTHERLIN LN
EUGENE OR
97405-9400
US

V. Phone/Fax

Practice location:
  • Phone: 541-653-9158
  • Fax: 541-653-8694
Mailing address:
  • Phone: 541-213-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number21657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number201805148NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: