Healthcare Provider Details

I. General information

NPI: 1932347119
Provider Name (Legal Business Name): IRIS CRAWFORD N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 LEARY WAY
SEATTLE WA
98107
US

IV. Provider business mailing address

6812 A OSWEGO PLACE NE
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-508-2957
  • Fax: 206-774-0668
Mailing address:
  • Phone: 206-508-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberND 1551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: