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General NPI Number Information
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NPI Number | 1922918192
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Entity Type | Individual
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Provider Name | STANLEY TODD CROCKER RD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 850 W MAPLE ST
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-5139
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Country | US
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Telephone | 509-565-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 537 BOYER AVE
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City | WALLA WALLA
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State | WA
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Zip | 99362-2010
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Country | US
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Telephone | 410-370-8871
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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 | 133VN1101X
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Taxonomy Name | Gerontological Nutrition Registered Dietitian
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License Number | DIET.DI.70161150
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License Number State | WA
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