MEDICARE: JUDITH KAY CRABTREE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP6276	CA

General Provider Information

NPI Number	:	1205998978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH KAY CRABTREE NP

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	MT SHASTA
State	:	CA
Zip	:	96067-0339
Country	:	US
Telephone Number	:	530-926-4528
Fax Number	:	530-926-5070

Provider Business Practice Location Address
First Line	:	824 PINE ST
Second Line	:
City	:	MT SHASTA
State	:	CA
Zip	:	96067
Country	:	US
Telephone Number	:	530-926-4528
Fax Number	:	530-926-5070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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