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NPI Code Detail

MEDICARE: STACEY CRAWFORD RN

MEDICARE: STACEY CRAWFORD RN
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
1163W00000XRegistered Nurse2007OR

General Provider Information

NPI Number : 1588088090
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY CRAWFORD RN
Provider Business Mailing Address
First Line : 9301 SW SAGERT ST APT 187
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7032
Country : US
Telephone Number : 503-895-7732
Fax Number :
Provider Business Practice Location Address
First Line : 5119 NE 57TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2584
Country : US
Telephone Number : 503-215-8062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2014
Last Update Date : 02/05/2014

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