Healthcare Provider Details

I. General information

NPI: 1457825200
Provider Name (Legal Business Name): RANNA KRAWCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SE ROGUE DR
GRANTS PASS OR
97526-4059
US

IV. Provider business mailing address

777 NE 7TH ST STE 208
GRANTS PASS OR
97526-1632
US

V. Phone/Fax

Practice location:
  • Phone: 541-659-0862
  • Fax: 541-295-8290
Mailing address:
  • Phone: 541-659-0862
  • Fax: 541-295-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number15-2350
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier017525830
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerIN HOME CAREGIVER AGNCY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: