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General NPI Number Information
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NPI Number | 1811676554
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Entity Type | Individual
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Provider Name | JILLIAN M CROSSGROVE BSM, CPM, LDM
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 21861 NE HIDDEN SPRINGS RD
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City | DUNDEE
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State | OR
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Zip | 97115-9124
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Country | US
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Telephone | 503-714-6457
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N 1ST ST
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City | CARLTON
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State | OR
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Zip | 97111-9642
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Country | US
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Telephone | 904-599-9691
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | DEM-LD-10226745
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License Number State | OR
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