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General NPI Number Information
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NPI Number | 1932710118
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Entity Type | Organization
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Legal Business Name | CAROL L. CROCKER, FNP PC
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 500 MAIN STREET SUITE A
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City | SPRINGFIELD
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State | OR
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Zip | 97477
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Country | US
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Telephone | 541-505-0027
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Fax | 541-505-7468
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Provider Business Mailing Address
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Address Line | 500 MAIN STREET SUITE A
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City | SPRINGFIELD
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State | OR
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Zip | 97477
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Country | US
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Telephone | 541-505-0027
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Fax | 541-505-7468
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL CROCKER
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Credential | FNP
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Telephone | 541-505-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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