Healthcare Provider Details

I. General information

NPI: 1053086348
Provider Name (Legal Business Name): REBECCA DIANE CRAWFORTH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 S HIGHLAND DR SUITE 2
SALT LAKE CITY UT
84106
US

IV. Provider business mailing address

3775 S HIGHLAND DR SUITE 2
SALT LAKE CITY UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 801-884-8030
  • Fax:
Mailing address:
  • Phone: 801-884-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69178
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10331826-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-183916
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: