Provider Demographics
NPI:1225452881
Name:CREPS, ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CREPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 21ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3417
Mailing Address - Country:US
Mailing Address - Phone:541-744-8743
Mailing Address - Fax:
Practice Address - Street 1:1623 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3417
Practice Address - Country:US
Practice Address - Phone:541-744-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist