MEDICARE: LILA CRUTCHFIELD 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
1	363LS0200X	School Nurse Practitioner	332760	CA

General Provider Information

NPI Number	:	1891824462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILA CRUTCHFIELD RN

Provider Business Mailing Address
First Line	:	1518 NOE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2315
Country	:	US
Telephone Number	:	415-648-0934
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 ALLSTON WAY BLDG H RM 105
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1463
Country	:	US
Telephone Number	:	510-644-6965
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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