Provider Demographics
NPI:1447458526
Name:CRAWFORD, CONNIE LOUISE (PHD, ARNP)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LOUISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-0066
Mailing Address - Country:US
Mailing Address - Phone:208-792-2505
Mailing Address - Fax:208-792-2882
Practice Address - Street 1:500 8TH AVE.
Practice Address - Street 2:SAM GLENN COMPLEX ROOM 42
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-792-2251
Practice Address - Fax:208-792-2882
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID17439A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily