MEDICARE: GRETCHEN JO ANNE CRAWFORD RNP

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	163W00000X	Registered Nurse	105766	AZ
2	363L00000X	Nurse Practitioner	235295	AZ

General Provider Information

NPI Number	:	1518510874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN JO ANNE CRAWFORD RNP

Provider Business Mailing Address
First Line	:	5956 E PIMA ST RM 2
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4375
Country	:	US
Telephone Number	:	520-204-0859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5956 E PIMA ST STE 130
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4384
Country	:	US
Telephone Number	:	520-204-0859
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	03/16/2026

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