Provider Demographics
NPI:1114627049
Name:CROCKETT, JAMANI
Entity Type:Individual
Prefix:
First Name:JAMANI
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMANI
Other - Middle Name:
Other - Last Name:LASHAWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10375
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:985 LEWIS AVE APT 9
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4293
Practice Address - Country:US
Practice Address - Phone:541-505-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175T00000XOther Service ProvidersPeer Specialist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN