Healthcare Provider Details

I. General information

NPI: 1053447664
Provider Name (Legal Business Name): MS. RENEE MARIE CRANK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/20/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NE 5TH ST
MCMINNVILLE OR
97128-4603
US

IV. Provider business mailing address

1652 NW WALLACE RD
MCMINNVILLE OR
97128-5166
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-7462
  • Fax: 503-434-9846
Mailing address:
  • Phone: 971-241-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: