Provider Demographics
NPI:1326174194
Name:CRAWFORD, CATHLEEN MARIE (PA)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5646
Mailing Address - Country:US
Mailing Address - Phone:530-743-7413
Mailing Address - Fax:530-743-7971
Practice Address - Street 1:724 5TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5646
Practice Address - Country:US
Practice Address - Phone:530-743-7413
Practice Address - Fax:530-743-7971
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAK23405Medicare UPIN