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General NPI Number Information
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NPI Number | 1700675741
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Entity Type | Individual
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Provider Name | JOSHUA FITZGERALD CRM
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Gender | Male
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 419 SW 5TH ST
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City | PENDLETON
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State | OR
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Zip | 97801-2020
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Country | US
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Telephone | 541-429-4940
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Fax | 541-429-4941
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Provider Business Mailing Address
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Address Line | 809 SW 6TH ST
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City | PENDLETON
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State | OR
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Zip | 97801-2928
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Country | US
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Telephone | 541-429-4940
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Fax | 541-429-4941
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 25-CRM-4390
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License Number State | OR
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