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General NPI Number Information
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NPI Number | 1750217113
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Entity Type | Individual
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Provider Name | ALEXANDRIA CRUM
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Gender | Female
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 833 SE MAIN ST STE 106
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City | PORTLAND
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State | OR
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Zip | 97214-3410
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Country | US
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Telephone | 972-832-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 N ALBINA AVE APT B204
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City | PORTLAND
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State | OR
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Zip | 97227-1397
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Country | US
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Telephone | 972-832-1414
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | BAP-E-10269644
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License Number State | OR
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