Healthcare Provider Details

I. General information

NPI: 1760729859
Provider Name (Legal Business Name): CHRISTINE CRALEN R.D., C.D.E
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FAIRVIEW ST
SILVERTON OR
97381-1917
US

IV. Provider business mailing address

4401 NE MALLORY AVE
PORTLAND OR
97211-3328
US

V. Phone/Fax

Practice location:
  • Phone: 971-983-5276
  • Fax: 971-983-5215
Mailing address:
  • Phone: 415-407-8340
  • Fax: 971-983-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number133V00000X
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: