Provider Demographics
NPI:1043093701
Name:CROGHAN, CLARE C (PA-C)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:C
Last Name:CROGHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1140
Mailing Address - Country:US
Mailing Address - Phone:712-642-2794
Mailing Address - Fax:712-642-9338
Practice Address - Street 1:1220 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2009
Practice Address - Country:US
Practice Address - Phone:712-755-5130
Practice Address - Fax:712-755-4445
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA120957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant