Healthcare Provider Details

I. General information

NPI: 1982953113
Provider Name (Legal Business Name): SARAH L CRAWFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 STATE ST
MEDFORD OR
97504-8475
US

IV. Provider business mailing address

2900 STATE ST
MEDFORD OR
97504-8475
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1672
  • Fax: 541-779-0986
Mailing address:
  • Phone: 541-779-1672
  • Fax: 541-779-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201391084NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: