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General NPI Number Information
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NPI Number | 1033675004
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Entity Type | Individual
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Provider Name | TRUMON OTTO CRAFT IV MSN, A-GNP
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Gender | Male
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 220 EAST AVE
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City | RIFLE
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State | CO
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Zip | 81650-2332
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Country | US
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Telephone | 970-625-5521
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Fax | 970-625-9336
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Provider Business Mailing Address
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Address Line | 220 EAST AVE
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City | RIFLE
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State | CO
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Zip | 81650-2332
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Country | US
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Telephone | 970-625-5521
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Fax | 970-625-9336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0995336-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN.0169891
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License Number State | CO
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