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General NPI Number Information
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NPI Number | 1750079729
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Entity Type | Individual
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Provider Name | CASSI JUNE ANN CRAWFORD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 1170 SE JEFFERSON ST APT 1
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City | DALLAS
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State | OR
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Zip | 97338-2861
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Country | US
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Telephone | 503-752-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 1170 SE JEFFERSON ST APT 1
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City | DALLAS
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State | OR
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Zip | 97338-2861
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Country | US
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Telephone | 503-752-4181
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 202008205CNA
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License Number State | OR
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