Provider Demographics
NPI:1033675004
Name:CRAFT, TRUMON OTTO IV (MSN, A-GNP)
Entity Type:Individual
Prefix:
First Name:TRUMON
Middle Name:OTTO
Last Name:CRAFT
Suffix:IV
Gender:M
Credentials:MSN, A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-2332
Mailing Address - Country:US
Mailing Address - Phone:970-625-5521
Mailing Address - Fax:970-625-9336
Practice Address - Street 1:220 EAST AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2332
Practice Address - Country:US
Practice Address - Phone:970-625-5521
Practice Address - Fax:970-625-9336
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995336-NP363LA2200X
CORN.0169891163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine