Healthcare Provider Details

I. General information

NPI: 1366497281
Provider Name (Legal Business Name): MARY KATHERINE CRABTREE DNSC., ANP, PROFESSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 SE BELMONT ST SUITE 60
PORTLAND OR
97215-1752
US

IV. Provider business mailing address

13045 SW KATHERINE ST
TIGARD OR
97223-1899
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5303
  • Fax:
Mailing address:
  • Phone: 503-590-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: