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General NPI Number Information
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NPI Number | 1922770403
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Entity Type | Individual
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Provider Name | JUSTIN AARON CRUTCHFIELD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2021
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Last Update Date | 10/02/2021
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2402
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Country | US
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Telephone | 808-691-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 332 OAKRIDGE LN
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City | LONGVIEW
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State | TX
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Zip | 75605-5956
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Country | US
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Telephone | 903-424-8324
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1056094
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License Number State | TX
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